Department of Obstetrics and Gynecology, S Chiara Hospital, Trento, Italy.
Department of Obstetrics and Gynecology, Maggiore della Carità Hospital, Università del Piemonte Orientale, Novara, Italy.
Acta Obstet Gynecol Scand. 2020 Sep;99(9):1238-1245. doi: 10.1111/aogs.13844. Epub 2020 Apr 3.
The aims of the study were to evaluate quality of life, cosmetic results and surgical outcomes of robotic single-site and robotic multiport total laparoscopic hysterectomy with sentinel lymph node mapping in women treated for low-risk endometrial cancer.
The study is a prospective, multicenter, case-control study conducted at Ospedale Santa Chiara in Trento and Novara and Pavia University Hospitals. Seventy-six consecutive patients with a biopsy-confirmed diagnosis of low-risk endometrial cancer or atypical endometrial hyperplasia who between January 2017 and January 2019 had undergone robotic total laparoscopic hysterectomy and sentinel lymph node mapping were included. Data on surgical outcomes, quality of life and cosmetic results were prospectively collected and analyzed based on the surgical approach with robotic single-site vs robotic multiport assistance. Patients' clinical characteristics, intra-operative parameters, sentinel lymph node mapping results and postoperative findings were prospectively recorded. Clinical follow up was performed 4 weeks and 6 and 12 months after surgery. Fifty-one patients underwent a robotic multiport procedure and 25 patients a robotic single-site surgery.
There was one significant difference between the two groups in terms of patient characteristics: mean body mass index (BMI) in the multiport group was 29 kg/m vs 24.8 kg/m in the single-site group (P value <.001). After univariate and multivariate analysis on intraoperative and postoperative findings, a shorter surgical time was observed in the single-site cohort than in the multiport group (148.7 vs 158.2 minutes, P value .0182). BMI also had a significant effect on surgical time (P = .022). No differences were seen in terms of sentinel lymph node detection: the bilateral detection rate was 96.1% for multiport (66.7% bilateral, 29.4% monolateral) and 96% for single-site (76% bilateral, 20% monolateral) procedures. No differences between the two approaches were identified with regard to postoperative complications, pain, cosmetic results or quality of life comparisons.
For the treatment of low-risk endometrial cancer and atypical endometrial hyperplasia with total hysterectomy and sentinel lymph node mapping, the robotic single-port approach is comparable to the multiport procedure in terms of intraoperative and postoperative findings, and has an advantage in terms of shorter surgical times. Further studies are required to identify possible differences in quality of life and cosmetic results.
本研究旨在评估机器人单部位和机器人多部位全腹腔镜子宫切除术联合前哨淋巴结定位术治疗低危子宫内膜癌患者的生活质量、美容效果和手术结果。
这是一项在特伦托和诺瓦拉的圣基亚拉医院和帕维亚大学医院进行的前瞻性、多中心、病例对照研究。2017 年 1 月至 2019 年 1 月期间，76 例经活检证实为低危子宫内膜癌或非典型子宫内膜增生的患者接受了机器人全腹腔镜子宫切除术和前哨淋巴结定位术。根据机器人单部位与机器人多部位辅助的手术方法，前瞻性收集并分析了手术结果、生活质量和美容效果的数据。前瞻性记录患者的临床特征、术中参数、前哨淋巴结定位结果和术后发现。临床随访在术后 4 周、6 个月和 12 个月进行。51 例患者接受了机器人多部位手术，25 例患者接受了机器人单部位手术。
两组患者的特征存在一个显著差异：多部位组的平均体重指数（BMI）为 29kg/m2，而单部位组为 24.8kg/m2（P 值<.001）。对术中及术后发现进行单变量和多变量分析后，单部位组的手术时间较多部位组短（148.7 分钟比 158.2 分钟，P 值<.0182）。BMI 对手术时间也有显著影响（P=.022）。在检测前哨淋巴结方面没有差异：多部位组的双侧检出率为 96.1%（66.7%双侧，29.4%单侧），单部位组为 96%（76%双侧，20%单侧）。两种方法在术后并发症、疼痛、美容效果或生活质量比较方面无差异。
对于低危子宫内膜癌和非典型子宫内膜增生患者行全子宫切除术和前哨淋巴结定位术，机器人单端口方法在术中及术后发现方面与多部位方法相当，手术时间更短。需要进一步的研究来确定在生活质量和美容效果方面可能存在的差异。
