The comparison of surgical outcomes and learning curves of radical hysterectomy by laparoscopy and robotic system for cervical cancer: an experience of a single surgeon

OBJECTIVE: The aim of this study was to compare and determine the feasibility, surgical outcomes, learning curves of robotic radical hysterectomy with lymph node dissection (RRHND) to conventional laparoscopic radical hysterectomy with lymph node dissection (LRHND) performed by a single surgeon, in patients with cervical cancer. METHODS: Between April 2009 and March 2013, 22 patients underwent LRHND and 19 patients underwent RRHND. Variables such as age, body mass index, International Federation of Gynecology and Obstetrics stage, histological results, number of dissected lymph nodes, operative time, estimated blood loss, days of hospitalization and complications were reviewed. Learning curves of operation time was obtained using cumulative sum (CUSUM) method. RESULTS: Both groups showed similar patient and tumor characteristics. In surgical outcome analysis, RRHND (51.8±10.4 minutes) showed longer preparing time than LRHND (42.5±14.1 minutes). In the LRHND group, 8 patients experienced postoperative complications (5 void difficulty, 1 postoperative bleeding, 1 right basal ganglia infarction, 1 fever). On the other hand, in the RRHND group, 4 patients experienced a postoperative complication (2 bleeding, 1 peritonitis, 1 dehiscence of trocar site). Using CUSUM method, the learning curves were obtained by plotting the cumulative sequential differences between each data point and the average operation time, and showed two distinct phases in both type of operations. CONCLUSION: RRHND would be appropriate surgical approach in patients with cervical cancer with favorable outcome of less voiding difficulty. A minimum of 13 cases of robotic radical hysterectomies are required to achieve surgical improvement in the treatment of cervical cancer.

Laparoscopic Surgery for Splenic Flexure Colon Cancer

Purpose: While a carcinoma of the splenic flexure is uncommon, is associated with a high risk of obstruction, and has a dual lymphatic drainage system, A COST study excluded transverse colon cancer, including splenic flexure colon cancer. This study reviews our experience with splenic flexure colon cancer treated laparoscopically and discusses a appropriate, safe laparoscopic surgical procedure. Methods: The authors reviewed the medical records of patients who underwent laparoscopic surgery for splenic flexure colon cancer from January 1995 to June 2006. The splenic flexure colon was defined as 5 cm from the splenic flexure proximally and distally by using radiologic studies. Curative surgery for splenic flexure colon cancer was defined as: primary cancer removal, a safe resected margin, no metastasis, and a complete lymphadenectomy including high ligation of left colic artery and of the left branch of the middle colic artery. Results: A total of 407 patients underwent laparoscopic surgery for colon cancer; among them, 15 patients underwent a laparoscopic left colectomy for splenic flexure colon cancer. The mean age of the patients was 63.8 years, and the male-to-female ratio was 9:6. The mean operation time was 325.3+/-95.1 minutes, and the average hospital stay was 15.8+/-4.9 days. The average number of harvested lymph nodes was 12.3+/-9.7, the average distal resection margin was 15.3+/-7.6 cm, and the average proximal margin was 10.7+/-3.2 cm. One case of chyle discharge and one case of ileus developed, but were treated conservatively. There was no surgical mortality. Conclusions: A laparoscopic left colectomy for splenic flexure colon cancer is a technically feasible and safe procedure with acceptable short-term outcomes in experienced hands.