The role of Robotics in Gynae-oncology at the North Midlands Cancer Centre
Mariam Nassar; Dulcidia Oniyere; Alex Tan
Royal Stoke Hospital, University Hospitals of North Midlands (UHNM)
Introduction
•Innovations with wristed computerised surgical tools led to the use of robotics in surgery.
•Indications for robotic- assisted surgery in gynae-oncology include uterine cancer, early cervical cancer, borderline tumour, early ovarian cancer and selected recurrent cancers.
•Patients who benefit most from robotics include morbid obese; fraility; those who decline blood transfusion; previous pelvic surgery, including midline incision; previous chemo-radiation; frozen pelvis from severe endometriosis or pelvic infection; bulky fibroid uterus and dense adhesions.
Methods
•We compared the standard of care and postoperative outcomes of robotic cases (Group A) against laparoscopic surgery (Group B) between January and August 2022
•Cases included atypical endometrial hyperplasia, early endometrial cancer, Stage 1A1/1A2 cervical cancer and suspicious complex-looking ovarian masses.
•A total of 44 patients were included (39 surgeries of which included hysterectomy), of which 20 were robotic and 24 were laparoscopic.
•Postoperative data was collected from iportal database, and operation notes and MDT summaries.
Results
•The standard of 100% was met in many aspects including pre-operative biopsy in endometrial patients, preoperative imaging, MDT discussion, recorded performance status, postoperative follow-up appointments and postoperative GP letters.
•The oldest patient in Group A was aged 81 compared with 82 in Group B. The highest BMI in Group A was 58 (148 kg) compared with 48 (128 kg) in Group B. Operative time in Group A was 29.5% between 91 to 180 minutes and 9% of more than 180 minutes (longest duration: 230 minutes) compared with 31.8% and 9% respectively in Group B (longest duration: 212 minutes). In Group A, significant blood loss was 10% (2/20 and highest loss: 850 ml) compared with 12.5% in Group B (3/24 and highest loss: 1000 ml). 50% (10/20) in Group A stayed as inpatients within 24 hours whilst the remaining stayed for at least 2 days (longest duration: 10 days). In Group B, 66.6 % stayed within 24 hours whilst 33.3% stayed for 2 to 4 days.
•Overall, there has been no major postoperative complications affecting both patient groups.
•Approximately 97.7% of postoperative thromboprophylaxis was documented in both groups. One patient in Group B had superficial thrombophlebitis in spite of Dalteparin prophylaxis. Only one patient in Group A was re-admitted to hospital with a pelvic haematoma but was conservatively managed with antibiotics and blood transfusion. There were no reported cases of anaesthetic complications or return to theatre for re-surgery.
Conclusion
•The use of robotic-assisted surgeries in Gynae-oncology is becoming increasingly popular as it overcomes limitations commonly encountered in laparoscopy.
•These indications favouring robotics include morbid obesity and challenging lymph node dissection in para-aortic and pelvic areas. We highly recommend more robotic surgeons and robot training opportunities in Gynae-oncology to deliver effective patient outcomes and educate trainee surgeons.
References
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2) Ismail, A., Wood, M., Ind, T., Gul, N., Moss, E (2020): The development of a robotic gynaecological surgery training curriculum and results of a delphi study. BMC Med Educ 20, 66 (2020). https://doi.org/10.1186/s12909-020-1979-y
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4) Marielle A. E. Nobbenhuis, Nahid Gul, Peter Barton-Smith, Orfhlaith O’Sullivan, Esther Moss, Thomas E. J. Ind, on behalf of the Royal College of Obstetricians and Gynaecologists (2022): Robotic surgery in gynaecology, Scientific Impact Paper No. 71 (July 2022).
