Robotic, Laparoscopic Surgery Compared In Uterine Cancer
Patients with endometrial cancer who have minimally invasive robotic-assisted hysterectomies tend to have quicker surgeries and shorter hospital stays compared with patients who have similar laparoscopic surgical procedures, according to new research from The Ohio State University Comprehensive Cancer – James Cancer Hospital and Solove Research Institute.
Until now, little data existed to confirm the benefit of minimally invasive robotic-assisted surgery for patients with endometrial cancer, also known as uterine cancer.
The study analyzed the results of surgeries for 105 patients conducted at The James between March 2006 and April 2008 using the da Vinci robot, compared to 76 patients who received minimally invasive laparoscopic surgery for uterine cancer, says principal investigator Dr. Jeffrey M. Fowler, director of the Division of Gynecologic Oncology and chief of staff at The James.
“Our study found that robotic hysterectomy and lymph node removal for uterine cancer results in shorter hospital stays and faster overall recovery with fewer complications compared with laparoscopic surgery,” says Fowler, who also is a researcher at Ohio State’s Comprehensive Cancer Center. “While this is still a major surgery, robot-assisted minimally invasive methods can greatly reduce blood loss, pain and scarring and risk of infection. We can now also use the technology in heavier patients.”
Fowler and his colleague Dr. David E. Cohn, were among the first surgeons nationwide to be certified to perform minimally invasive robotic-assisted surgery on patients with gynecologic cancer. Fowler and Cohn, who both specialize in gynecologic oncology, are routinely using robotic instrumentation to perform hysterectomies and lymph node dissections for treating uterine cancer, and they train other surgeons in the technique.
For years, robotic-assisted surgery has been used in heart and prostate surgeries. In 2005, the federal Food and Drug Administration approved the minimally invasive technique for treatment of gynecological disorders, including hysterectomies (removal of the uterus) and myomectomies (removal of uterine fibroids). Typically, these procedures have required large abdominal incisions that result in more blood loss and longer hospital stays and recovery times, says Fowler.
Minimally invasive laparoscopic surgery is less invasive than open abdominal surgery. A laparoscope viewing tube is inserted into the abdomen through a small incision, allowing the surgeon to examine the abdominal and pelvic organs on a video monitor. Other small incisions are made to insert instruments to perform procedures.
Doctors began using laparoscopic surgery in 1993 to treat early stage uterine cancer. The benefits of a laparoscopic approach are lower blood loss and transfusion rates, shorter hospital stay, faster post-operative recovery and superior short-term quality of life. However, laparoscopic surgery usually requires longer operations and a steeper learning curve for surgeons compared to robotic-assisted surgery, particularly among obese patients.
Lymph nodes are also removed during the procedure and examined for the presence of cancerous cells to help determine whether the cancer has spread.
This procedure can be accomplished using both minimally invasive surgical techniques, but is more difficult during laparoscopic surgery, Fowler says.
“Typically, patients with uterine cancer tend to be overweight or obese with high blood pressure and diabetes, and therefore are at greater risk for post-surgical complications, especially wound healing,” says Fowler. “Our study showed that overweight or obese patients can benefit most from this approach.”
Endometrial cancer is the most common gynecologic cancer, with about 40,000 cases diagnosed each year in the United States, Fowler said. It is the fourth-most common cancer in women, and an estimated 7,400 women will die from it each year, he says.
As pioneers in the use of robotics for gynecologic cancer procedures, Fowler and Cohn have worked closely with Ohio State researchers to publish additional studies related to minimally invasive robotic-assisted surgery for gynecologic cancers. The studies have been published in recent issues of the journal of Obstetrics & Gynecology and the Journal of Robotic Surgery.
“We have found that robotic-assistance enables greater precision during surgery,” Fowler says. “When it comes to treating patients with uterine cancer, this is now the procedure of choice in our practice.”