Tumor recurrence does not appear increased with robotics compared to laparoscopy. At a mean length of follow-up of 31.1 months (range, 10 to 50 months), none of the patients in the robotic group experienced recurrence, and there was no difference with the laparoscopy group (50).
62.5 mL, no intraoperative complications, no blood transfusions, no conversions to laparotomy, and a median length of hospital stay of 1.5 days (63). The median number of pelvic lymph nodes removed was 20.
The laparoscopic approach to pelvic and aortic lymphadenectomy prior to chemoirradiation for patients with advanced cervical cancer is well documented, both transperitoneal and extraperitoneal (64–69). There are many studies discussing robotic pelvic and aortic lymphadenectomy included in the treatment of patients with different types of gynecologic malignancies, including cervical, endometrial, and ovarian malignancies (16,49,50,55–58,70,71).
A novel technique and the results of robotic transperitoneal infrarenal aortic lymphadenectomy in 33 patients with different gynecologic cancers was reported (72). The requirement of this technique was the placement of the robotic column at the patient’s head, which mandated the rotation of the operating table 180 degrees after completion of the robotic pelvic operation and the insertion of additional trocars in the lower pelvis (72). The mean console time was 42 minutes, the mean number of nodes 12.9, and the mean number of positive nodes 2.6. There was one conversion to laparotomy caused by bleeding. These results are comparable to those reported with laparoscopic aortic lymphadenectomy. Placing the robotic column at the patient’s head and inserting additional trocars in the lower pelvis were requirements to remove the infrarenal aortic nodes with robotics. Previous attempts to remove the left infrarenal aortic lymph nodes in a frozen cadaver were unsuccessful when the robotic column was stationed at the level of the patient’s feet.
The feasibility of the extraperitoneal robotic approach to aortic lymphadenectomy was reported (73,74). The development of the robotic extraperitoneal technique in frozen cadavers, successfully applied to a patient with cervical cancer stage IB2 presenting with enlarged left aortic lymph nodes, is reported (73). It was noted that appropriate placement of the robotic trocars and the robotic column is necessary to prevent robotic arm collision and to reach the different aortic lymph nodal areas. The operating, docking, and console times were 103, 3.5, and 49 minutes, respectively. The blood loss was 30 mL. Selective removal of five enlarged aortic lymph nodes revealed no evidence of metastases.
Another study by Vergote et al. reported the development of their technique for inframesenteric aortic lymphadenectomy in five patients (74). All console times were less than 1 hour. The operating times and number of aortic lymph nodes in both studies are within the range of those reported with the laparoscopic approach. Both studies concluded that the robotic approach was technically easier than the conventional laparoscopy procedure (73,74).
Robotic anterior pelvic exenteration was described in three patients with recurrent cervical cancer (75). The operating times (range, 480 to 600 minutes) are longer than for laparotomy, but blood loss (range, 200 to 500 mL) is markedly lower. The length of hospital stay was similar or longer than by laparotomy (range, 25 to 53 days). Patients required a pararectal incision (10 cm) for the pouch construction, and one patient with vaginal reconstruction had a perineal phase. Whether the robotic approach to pelvic exenteration will become preferable to laparotomy is unknown.