ABSTRACT Objectives: The purpose was to compare robotic assisted total laparoscopic hysterectomy (TRH), laparoscopic assisted hysterectomy (TLH) and total abdominal hysterectomy (TAH) with surgical staging +/- lymphadenectomy for the management of uterine cancer. Methods: Institutional review board approval was obtained and patient characteristics, pathologic data, and data related to the surgical procedure were collected from chart review. Data were analyzed with SAS statistical software. Results: A total of 102 TRHs were compared to 115 TLHs and 79 TAHs. There were more grade I and endometrial intraepithelial (EIN) lesions in the preoperative pathology of TLHs (P < 0.01). Pelvic lymphadenectomy was performed in 71 (70%) TRH, 46 (58%) TAH, and 28 (24%) TLH cases (P < 0.01). Mean surgical time was 203, 133 and 132 minutes for TRHs, TLHs, and TAHs (P < 0.05). Estimated blood loss was 69, 86, and 215 ml for TRH, TLH, and TAH (P < 0.05). Blood transfusions were 19% in TAHs versus 3% and 2% in TLHs and TRHs (P < 0.01). There were fewer wound infections (2% vs. 10%) in TRHs versus TAHs (P < 0.01). Length of stay was shorter for the TRH and TLH groups (P < 0.05). Conclusion: Despite longer surgical times, benefits of minimally invasive technology included shortened length of stay, decreased wound infections, transfusions, and blood loss. In our population, procedure selection for TLH versus TRH may have been influenced by lower preoperative grade, with reservation of robotic technology for cases anticipated to be more complex, and therefore justifying increased technology costs and operating times.
Cite this paper
N. Nicole, C. Rachel, M. Michael, B. Ross, G. Sue, V. Allison and F. Colleen, "Robotic Assisted, Total Laparoscopic, and Total Abdominal Hysterectomy for Management of Uterine Cancer," Journal of Cancer Therapy, Vol. 3 No. 2, 2012, pp. 162-166. doi: 10.4236/jct.2012.32022.
 A. Jemal, R. Siegel, E. Ward, et al., “Cancer Statistics, 2008,” CA: A Cancer Journal for Clinicians, Vol. 58, No. 2, 2008, pp. 71-96. doi:10.3322/CA.2007.0010
 J. Mikuta, “International Federation of Gynecology and Obstetrics Staging of Endometrial Cancer,” Cancer, Vol. 71, 1988, pp. 1460-1463.
 J. Walker, R. Mannel, M. Piedmonte, J. Schlaerth, N. Spirtos and G. Spiegel, “Phase III Trial of Laparoscopy (scope) vs. TAH (open) for Surgical Resection and Comprehensive Surgical Staging of Uterine Cancer: A Gynecologic Oncology Group (GOG) Study Funded by NCI,” Gynecologic Oncology, Vol. 101, 2006, pp. S11-S12.
 K. Hatch, “Laparoscopic Lymphadenectomy and Laparoscopic-Assisted Vaginal Hysterectomy (Editorial),” Gynecologic Oncology, Vol. l90, 2003, pp. 503-504.
 S. Ribeiro, R. Ribeiro, N. Santos and J. Pinotti, “A Randomized Study of Total Abdominal, Vaginal, and Laparoscopic Hysterectomy,” International Gynecology & Obstetrics, Vol. 83, No. 1, 2003, pp. 37-43.
 Y.-H. Cho, D.-Y. Kim, J.-H. Kim, Y.-M. Kim, Y.-T. Kim and J.-H. Nam, “Laparoscopic Management of Early Uterine Cancer: 10 Year Experience in an Asian Medical Center,” Gynecologic Oncology, Vol. 106, No. 3, 2007, pp. 585-590. doi:10.1016/j.ygyno.2007.05.011
 J. Boggess, P. Gehrig, L. Cantrell, A. Shafer, M. Ridgeway, E. Skinner and W. Fowler, “A Comparative Study of 3 Surgical Methods for Hysterectomy with Staging for Endometrial Cancer: Robotic Assistance, Laparoscopy, Laparotomy,” American Journal of Gynecologic Oncology, Vol. 199, No. 4, 2008, pp. 360.e1-360.e9
 S. Denardis, R. Holloway, I. Bigsby, P. Dirk, S. Ahmad and N. Finkler, “Robotically Assisted Laparoscopic Hysterectomy versus Total Abdominal Hysterectomy and Lymphadenectomy for Endometrial Cancer,” Gynecologic Oncology, Vol. 111, No. 3, 2008, pp. 412-417.
 M. Bell, J. Torgerson, U. Seshadri-Kreaden, A. Wierda Suttle and S. Hunt, “Comparison of Outcomes and Cost for Endometrial Cancer Staging via Traditional Laparotomy, Standard Laparoscopy and Robotic Techniques,” Gynecologic Oncology, Vol. 111, No. 3, 2008, pp. 407-411. doi:10.1016/j.ygyno.2008.08.022
 D. Holtz, G. Miroshnichenko, M. Finnergan and C. Dunton, “Endometrial Cancer Surgery Costs: Da Vinci Robot versus Laparoscopy,” Gynecologic Oncology, Vol. 108, Suppl. 1, 2008, p. A322.
 L. Seamon, M. Henretta, K. Kim, M. Carlson, D. Cohn and J. Fowler, “Robotic versus Laparoscopic Hysterectomy and Lymphadenectomy for Endometrial Cancer: Conversion Rates and Operating Time,” Gynecologic Oncology, Vol. 108, Suppl. 1, 2008, p. A142.
 R. Hanna, L. Cantrell, A. Gehrig, J. Mendivil and J. Boggess, “A Cost Analysis of Robotic Surgery as Compared with Conventional Laparoscopy for Endometrial Cancer Staging,” Gynecologic Oncology, Vol. 112, Suppl. 1, 2009, p. A330.
 M. Lowe, D. Chamberlain, P. Johnson, S. Kamelle and T. Tillmans, “Multi-Institutional Gynecologic Robotic Surgical Consortium: Analysis of Perioperative Outcomes Associated with the Utilization of Robotics in the Surgical Management of Endometrial Cancer,” Gynecologic Oncology, Vol. 112, Suppl. 1, 2009, p. A333.