Robotic-assisted total laparoscopic hysterectomy and staging for the treatment of endometrial cancer: a comparison with conventional laparoscopy and abdominal approaches.

The treatment of endometrial cancer using a minimally invasive approach provides benefits to the patient; however, there are currently few papers comparing robotic total laparoscopic hysterectomy with staging to conventional laparoscopic and abdominal approaches. Analyses of 102 consecutive patients undergoing robotic total hysterectomy were compared to historical cohorts of 104 patients undergoing laparoscopic total hysterectomy and 78 patients undergoing abdominal total hysterectomy (laparotomy). The majority of all patients were FIGO'88 stage IB. Patient characteristics were similar, except for lower age (P = 0.0236) and body mass index (P = 0.0134) in the laparoscopy group when compared to laparotomy. Operative time was longer for the robotic group at 108.7 min, compared to 79.4 min for laparoscopy (P = 0.0207) and 84.0 min for laparotomy (P < 0.0001). Lymph node yield was significantly higher in the robotic group (16.0 nodes) when compared to both laparoscopy (5.0 nodes, P < 0.0001) and laparotomy (11.4 nodes, P = 0.0006). The perioperative complication rates were significantly decreased in both the robotic (10.8%) and laparoscopy (6.7%) groups when compared to laparotomy at 25.6% (P = 0.0089; P = 0.0002). Hospital stay was significantly reduced in both the robotic (1.9 days, P < 0.0001) and laparoscopic (1.8 days, P < 0.0001) groups when compared to laparotomy (4.1 days). Both minimally invasive approaches reduced morbidity. Robotic assistance resulted in improved lymph node yield. Robotic surgery for endometrial cancer is at least equivalent to laparoscopic and open techniques and may be the preferred method for treatment of endometrial cancer.