The New Indian Journal of OBGYN. 12(1):158-162

Radical hysterectomy in cancer cervix: experience after adoption of robotic surgery

Kavita Mahadevappa, Uttam D Bafna, Pallavi V Ramachandra, Naveen Prasanna

ABSTRACT

Background: Radical hysterectomy type III with pelvic lymphadenectomy is the surgical management for early cancer cervix. This study aims to know the perioperative and pathological outcomes of radical hysterectomy with bilateral salpingo-ophorectomy and pelvic lymphadenectomy in early cancer cervix done by open, laparoscopic and robotic routes. Methods: This was a prospective study conducted in KIDWAI Cancer Institute, Bangalore, India from December 2016 to June 2019. Cancer cervix stage 1B to IIA undergoing radical hysterectomy were included in the study. Demographic profile of patients, duration of surgery, intraoperative and postoperative findings, complications, specimen details and pathology reports were analysed. Data analysis was carried out using Python 3.7 version. Pearson Chi square test and Kruskal-Wallis test were used. P value <0.05 was considered statistically significant. Results: There were 60 patients, 20 each in open radical hysterectomy (ORH), laparoscopic radical hysterectomy (LRH) and robotic radical hysterectomy (RRH) groups. Median duration of surgery (minutes) was more in RRH (196) compared to LRH (180) and ORH (180), (p=0.029). The intraoperative blood loss (ml) was least in LRH (100), RRH(200) and more in ORH (300), ( p=0.0001). Median duration of stay (days) were ORH(5), LRH(4), RRH(4), (p=0.0001). There were no conversions to laparotomy in LRH or RRH group. There were no bowel, bladder or vascular injury in RRH group. The number of lymphnodes retrieved were similar in all the groups (15vs12vs12 with ORH, LRH, RRH). However parametrial and the vaginal length were significantly less in RRH (left parametrium 1cm and right parametrium 1cm, vaginal length 1cm). Conclusion: Robotic radical hysterectomy has lesser blood loss, shorter hospital stay and lesser Intraoperative and postoperative complications. The parametrial and vaginal margin length obtained were least in robotic radical hysterectomy. Surgical experience is of paramount importance along with route of surgery.