The International Journal of Medical Robotics and Computer Assisted Surgery

Feasibility and Outcomes of a Robotic Retroperitoneal Approach to Para‐Aortic Lymphadenectomy in Intermediate‐ and High‐Risk Endometrial Cancer: A Prospective Study

ABSTRACT Background This prospective feasibility study evaluated the safety and efficacy of robotic retroperitoneal para‐aortic lymphadenectomy in patients with intermediate‐to high‐risk endometrial cancer. Methods Patients with endometrial cancer who underwent robotic surgical staging at Mie University Hospital between October 2021 and May 2025 were prospectively enroled and analysed following ethics approval. Patient clinical data, intraoperative parameters, and postoperative quality of life (QOL) were collected according to a predefined protocol. Results The study included 18 patients with a median operative time of 411.0 min, median blood loss of 51.0 mL, and 25.5 and 24.5 resected pelvic and para‐aortic lymph nodes, respectively. Para‐aortic lymph node metastasis was observed in one case, and postoperative complications in two. QOL returned to baseline within 28 days postoperatively. Conclusions The robotic retroperitoneal approach to para‐aortic lymphadenectomy is a feasible and safe staging procedure for intermediate‐to high‐risk endometrial cancer, with rapid postoperative QOL recovery. Trial Registration This study was registered in the Japan Registry of Clinical Trials (jRCT1042210047).

Robotic Single‐Port Versus Robotic Single‐Site Hysterectomy in Early Endometrial Cancer: A Case Control Study

ABSTRACT Objective To compare surgical outcomes of robotic single‐port (RSPH) versus single‐site (RSSH) hysterectomy in early‐stage endometrial cancer. Methods This is a retrospective case‐control study, comparing surgical outcomes of RSPH (Cases) and RSSH (Controls) in early‐stage endometrial cancer. Results Twenty‐five women who underwent RSPH from June 2024 to November 2024 were matched with 50 historical RSSH controls treated at the same institution by the same surgical team between December 2011 and September 2014. Operation time was similar: 110 min in RSPH and 99 min in RSSH ( p  = 0.76). Blood loss was 50 mL in RSPH and 60 mL in RSSH ( p  = 0.14). Hospital stay was shorter in RSSH (3.5 days in RSPH and 3 days in RSSH, p  = 0.001). Conclusions Our study confirms the safety and feasibility of RSPH for endometrial cancer without major differences from the RSSH in terms of surgical outcomes.

Robotic radical hysterectomy for stage 1B1 cervical cancer: A case series of survival outcomes from a leading UK cancer centre

AbstractBackgroundWe present the largest UK single institute robotic radical hysterectomy (RRH) case series for the management of cervical cancer (CC).MethodsData were collected on women who had a RRH as primary treatment for stage 1b1 CC between December 2009 and December 2018.ResultsNinty women had a robotic hysterectomy. Five‐year follow‐up data were available for 30%. The disease‐free survival at 5 years was 89.6%. Overall survival at 3 and 5 years for death from any cause was 96.1% and 91.4%, respectively. The overall 5‐year survival for death from disease only was 92.8%. Overall survival by tumour size alone showed that women with tumours less than 2 cm had a 98.3% 5‐year survival compared to 83.4% for tumour size greater than 2 cm. Irrespective of tumour size, those that had no evidence of lymphovascular space invasion had a 100% 5‐year survival.ConclusionOur preliminary data supports the oncological safety of RRH in a selective cohort of patients with stage 1b1 CC.

Robot‐assisted modified radical hysterectomy with removal of lymphatic vessel using indocyanine green: A new method

AbstractBackgroundThe sentinel lymph node (SLN) procedures using indocyanine green (ICG) have recently been performed worldwide. The aim of this study was to emphasise the safety of robot‐assisted modified radical hysterectomy (RAMRH) with removal of the lymphatic vessels (RLV) using ICG in endometrial cancer according to a single surgeon's experience.MethodsRobot‐assisted modified radical hysterectomy with RLV using ICG was performed in patients with endometrial cancer. We compared 34 cases of RAMRH with RLV, with 54 patients without RLV.ResultsThe median (interquartile range) time for the procedure did not differ between the RAMRH with and without RLV groups (88 [80–114] vs. 88 [79–104] min, p = 0.7). The success rate of RLV was 100% when SLNs were detected.ConclusionRobot‐assisted modified radical hysterectomy with RLV using ICG can completely dissect tissue from the uterus, including lymphatic vessels. This procedure using a robotic system with ICG, is simple and does not require additional time.

Does the use of a uterine manipulator in robotic surgery for early‐stage endometrial cancer affect oncological outcomes?

AbstractBackgroundTo investigate the impact of the use of a uterine manipulator in robot‐assisted surgery for early‐stage endometrial cancer on oncological outcome.MethodsEighty six robotic surgeries and sixty seven open surgeries were performed for early‐stage endometrial cancer. Disease‐free survival and overall survival at 5 years, and surgical results and postoperative complications were compared between surgeries. In robotic surgery, a uterine manipulator was used in all cases.ResultsThere was no significant difference in oncological outcome between surgeries. Robotic surgery showed significantly longer operative time, less blood loss, and shorter hospital stay compared to open surgery. In robotic surgery, complications occurred significantly less frequently, and no patients required conversion to laparotomy. There were no clear correlations of positive lavage cytology with The International Federation of Gynecology nd Obstetrics stage, recurrence, and site of recurrence in either surgery.ConclusionsThe use of a uterine manipulator during robotic surgery for early‐stage endometrial cancer did not influence recurrence or survival.

Comparison between single‐site and multiport robot‐assisted hysterectomy in obese patients with endometrial cancer: An Italian multi‐institutional study

AbstractBackgroundThe aim of this study is to compare robotic single‐site hysterectomy (RSSH) and robotic multiport hysterectomy (RMPH) for endometrial cancer (EC) in obese patients in terms of surgical outcomes.MethodsThis retrospective study compares RSSH with RMPH in obese patients with EC and FIGO stages I to II divided in three classes according to their body mass index (BMI): class A (30‐34.9 kg/m2), class B (35‐39.9 kg/m2), and class C (>40 kg/m2).ResultsWe included 225 patients (RSSH: 76; RMPH: 149). The operative time and estimated blood loss (EBL) were lower in the A class of the RSSH group. The EBL and the conversion rate increased when the BMI increased in the RSSH group. The hospital stay was higher in the A class of the RMPH group.ConclusionsThe advantages of RSSH in terms of reduced invasiveness remain true only in the first BMI class, whereas they are lost when the BMI increased.

Robotic single‐site versus multiport radical hysterectomy in early stage cervical cancer: An analysis of 62 cases from a single institution

AbstractBackgroundThis study aimed to compare the surgical outcomes and cost of robotic single‐site radical hysterectomy (RSSRH) versus robotic multiport radical hysterectomy (RMPRH) with pelvic lymph node dissection in early stage cervical cancer.MethodsSixty‐two patients with early stage cervical cancer were recruited between November 2011 and July 2017 and underwent RSSRH (20 patients) and RMPRH (42 patients) for early stage cervical cancer using the da Vinci Si Surgical System (Intuitive Surgical).ResultsThere were no significant difference between the two groups in most of parameters. However, postoperative hospital discharge and total hospital costs for RSSRH were significantly shorter than RMPRH (both p < 0.001). However, lymph node retrieval of RMPRH was significantly higher than RSSRH in (18.0 vs. 9.5, respectively; p < 0.001).ConclusionsRSSRH has comparable surgical outcomes to the RMPRH method. RSSRH could be considered a surgical option in a well‐selected patient group.