Lee Hyun Jung, Lee Yoon Hee, Chong Gun Oh, Hong Dae Gy, Lee Yoon Soon
Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
J Obstet Gynaecol Res. 2018 Mar;44(3):547-555. doi: 10.1111/jog.13535. Epub 2017 Dec 14.
This study was conducted to evaluate the clinical feasibility of robotic-assisted transperitoneal infrarenal para-aortic lymphadenectomy (TIPAL) in patients with endometrial cancer.
From June 2006 to October 2016, we retrospectively analyzed 42 patients who underwent laparoscopic (n = 16) or robotic-assisted (n = 26) staging operations, including TIPAL for endometrial cancer. Perioperative data including age; body mass index; operation duration; the number of lymph nodes retrieved and the ratio of time to lymph node retrieval during pelvic, infrarenal para-aortic and total lymphadenectomy; estimated blood loss and postoperative complications were compared.
The operative duration of pelvic (21.7 ± 5.31 vs 30.7 ± 10.8 min; P = 0.002), and total (62.6 ± 14.0 vs 87.0 ± 30.4 min; P = 0.010) lymphadenectomy was significantly shorter in the robotic-assisted than the laparoscopic group, whereas there was no statistical difference in the duration of infrarenal para-aortic lymphadenectomy. By contrast, the number of infrarenal para-aortic lymph nodes retreived was significantly higher (29.4 ± 10.7 vs 23.3 ± 9.16; P = 0.016) in the robotic-assisted group. Consequently, the ratio of time to number of lymph nodes retrieved during infrarenal (1.51 ± 0.49 vs 2.62 ± 1.34; P = 0.002) and total (1.43 ± 0.48 vs 2.15 ± 0.93; P = 0.014) lymphadenectomy was lower in the robotic-assisted compared to the laparoscopic group.
The robotic-assisted approach took less time per infrarenal para-aortic and total lymph nodes retrieved compared to the conventional laparoscopic approach. Robotic-assisted TIPAL could be feasible and effective for the staging and treatment of patients with endometrial cancer.
本研究旨在评估机器人辅助经腹肾下主动脉旁淋巴结清扫术（TIPAL）在子宫内膜癌患者中的临床可行性。
回顾性分析2006年6月至2016年10月期间接受腹腔镜（n = 16）或机器人辅助（n = 26）分期手术（包括子宫内膜癌的TIPAL）的42例患者。比较围手术期数据，包括年龄、体重指数、手术时间、盆腔、肾下主动脉旁及全淋巴结清扫术中获取的淋巴结数量及获取淋巴结时间占比、估计失血量和术后并发症。
机器人辅助组盆腔淋巴结清扫术（21.7±5.31对30.7±10.8分钟；P = 0.002）及全淋巴结清扫术（62.6±14.0对87.0±30.4分钟；P = 0.010）的手术时间明显短于腹腔镜组，而肾下主动脉旁淋巴结清扫术的时间无统计学差异。相比之下，机器人辅助组肾下主动脉旁淋巴结获取数量明显更多（29.4±10.7对23.3±9.16；P = 0.016）。因此，机器人辅助组肾下（1.51±0.49对2.62±1.34；P = 0.002）及全（1.43±0.48对2.15±0.93；P = 0.014）淋巴结清扫术中获取淋巴结时间占比低于腹腔镜组。
与传统腹腔镜方法相比，机器人辅助方法在获取肾下主动脉旁及全淋巴结时花费的时间更少。机器人辅助TIPAL对子宫内膜癌患者的分期和治疗可能是可行且有效的。
