Comparison of robotic-assisted vs conventional laparoscopy for extraperitoneal paraaortic lymphadenectomy

Perioperative morbidity and rate of upstaging after laparoscopic staging for patients with locally advanced cervical cancer: results of a prospective randomized trial

“…21,26,38,39 Currently, surgical staging is performed almost exclusively using conventional laparoscopy (via either the transperitoneal or extraperitoneal approach) 9,12,14,16,27 or robotic laparoscopy. 11,17 To facilitate pelvic lymph node removal as a part of comprehensive staging, most of the operative procedures in our study used transperitoneal laparoscopy (93.4%). The average number of harvested paraaortic lymph nodes in arm A of our study was 17, which is therefore in the upper range of the international standard (between 7 and 27).…”

“…Robotic techniques were not used in our study; however, conventional laparoscopy and robotic surgery appear to be equivalent. 11,17,27 In retrospective series, the mean waiting time before RCTX after paraaortic surgical staging varies between 10 and 35 days. 9,12,14,27,40,41 In our prospective, randomized, multicenter trial, this parameter (13 days) also met the recommended interval.…”

“…12,13 The preferred approaches for surgical staging are laparoscopic or robotic transperitoneal or extraperitoneal techniques to minimize the duration of hospitalization and avoid delaying primary RCTX. 8,11,[14][15][16][17] Several retrospective studies have demonstrated a significant rate of upstaging, mainly determined by nodal or peritoneal spread, as a confirmation of more extensive disease, in a nontrivial number of patients when comparing the results of clinical standard staging with histological features after surgery. 12,13,16,[18][19][20][21][22] However, controversy remains regarding whether adjusting the primary treatment according to the findings of surgical staging is associated with a survival benefit.…”

Minimally Invasive Surgery to Treat Gynecological Cancer

“…Table 8 shows the main results of studies comparing conventional with robotic-assisted laparoscopy with or without laparotomy in women undergoing para-aortic lymphadenectomy for gynecological cancer. 43,44 The studies did not identify significant clinical differences among investigated parameters such as surgical time, complications, number of nodes removed, EBL, or length of stay. The study of Díaz-Feijoo et al 44 only found a significantly higher number of aortic nodes removed by robot (absolute mean difference: 17 in robot vs 14 in laparoscopy) and in EBL (absolute mean difference: 20 mL in robot vs 90 in laparoscopy), although both differences have limited clinical relevance.…”

Tailored Radiotherapy Treatment in Advanced Cervical Cancer. Early Experience of Robotics in Surgical Innovation

“…are unresolved questions that need for controlled trials. In January 2014 the largest series of robotic extraperitoneal paraaortic lymphadenectomy has been published by the group of Vall D´Hebron [22]. They obtained a higher number of nodes when robotics are used instead of classical laparoscopy comparing it with a retrospective series of their group by classical laparoscopy (17 vs 14, p<0,05), with decreased blood loss (20ml vs 90ml, p<0,05) without differences on postoperative complications.…”