Robotic surgery implementation in an isolated overseas territory - The case of Reunion Island.

INTRODUCTION: In February 2020, robotic surgery was introduced in University Hospital of St Pierre in Reunion Island. The aim of this study was to evaluate the implementation of robotic assisted surgery in the hospital and its impact on operating times and patient outcomes. METHODS: Data was prospectively collected on patients undergoing laparoscopic robotic assisted surgery between February 2020 and February 2022. Information included patient demographics, type of surgery, operating times and length of stay. RESULTS: Over the two-year study period, 137 patients underwent laparoscopic robotic assisted surgery performed by 6 different surgeons. 89 of the surgeries were in gynecology, including 58 hysterectomies, 37 were in digestive surgery, and 11 in urology. The installation and docking times decreased across all specialties and were found to be significantly reduced when comparing the first and last 15 hysterectomies: mean installation time decreased from 18.7 to 14.5 minutes (p=0.048), mean docking time decreased from 11.3 to 7.1 minutes (p = 0.009). CONCLUSIONS: The implementation of robotic assisted surgery in an isolated territory such as Reunion Island was slow due to a lack of trained surgeons, supply difficulties and Covid crisis. Despite these challenges, the use of robotic surgery allowed for technically more challenging surgeries and demonstrated similar learning curves to other centers.

Conservative treatment of glassy cell cervical cancer: A case report.

Glassy cell carcinoma (GCC) constitutes a rare yet histologically aggressive subtype of cervical cancer known for its rapid proliferation and high risk of recurrence and metastasis. Due to its low prevalence, the medical literature lacks large retrospective and prospective studies, and thus, no standardized management has been defined. The recommended treatment for GCC is radical hysterectomy with bilateral pelvic lymphadenectomy; however, since it mainly affects young women of reproductive age, data in the literature suggest conservative management, such as radical trachelectomy. The present report describes the cases of 2 young patients treated conservatively with pelvic lymphadenectomy and radical trachelectomy for early-stage GCC of the cervix. The first patient was a 37-year-old patient who presented a 15-mm GCC tumor [International Federation of Gynecology and Obstetrics (FIGO) stage IB1], and the second patient was a 23-year-old patient who presented a 14-mm GCC tumor (FIGO stage IB1). The first patient presented early vaginal recurrence 3 months postoperatively, which was treated with concomitant pelvic chemoradiation (45 Gy) followed by vaginal and uterine brachytherapy (15 Gy). The second patient presented internal iliac nodal recurrence 1 year after treatment, which was treated by carboplatin-paclitaxel-Avastin-based chemotherapy, followed by laparoscopic paraaortic lymph node dissection and pelvic chemoradiation (45 Gy). Both patients were tumor-free after 5 and 6 years, respectively. Due to the aggressiveness of GCC of the cervix and its high risk of recurrence, conservative treatment should be considered cautiously and should not be the standard of care.