Li Ya, Na Jing, Wang Xinyou, Han Shichao, Wang Jun
Obstetrics and Gynecology department, the second affiliated hospital of Dalian Medical University, Dalian, China.
Front Oncol. 2024 Oct 15;14:1466921. doi: 10.3389/fonc.2024.1466921. eCollection 2024.
Radical hysterectomy has been established as the standard treatment for early stage cervical cancers. Despite numerous efforts to standardize the technique for radical hysterectomy across varying extents of tumor invasion, success has been inconsistent. Total Müllerian Compartment Resection (TMCR), an ontogenetic compartment-based oncologic surgery initially developed for open procedures by Professor Höckel, offers a standardized approach applicable to all patients with locally confined tumors. This method holds promise for achieving thorough oncologic clearance while maintaining acceptable complication rates. Moreover, robotic-assisted surgery may further reduce morbidity compared to open surgery. In this context, we provide a detailed step-by-step description of robotically assisted Total Müllerian Compartment resection (R-TMCR) for cervical cancer and present feasibility data from a cohort of 20 patients.
20 patients with stage IA1-IB2 cervical cancer, robot-assisted resection of the Müllerian embryonic compartment was undertaken. Key metrics such as operative duration, intraoperative blood loss, and postoperative complication rates were meticulously recorded and analyzed.
The duration of the surgery varied from 185 to 500 minutes, with intraoperative blood loss ranging between 5 mL and 300 mL. Postoperative hemoglobin levels dropped by -15 to 40 g/L from their preoperative values. Notably, there were no instances necessitating conversion to open surgery, and no intraoperative complications occurred. The rate of postoperative complications was 0%. Over the follow-up period, which averaged 18 months, there were no observed locoregional recurrences of cervical cancer, nor were there any deaths attributed to cervical cancer during this time.
The application of robotic Müllerian compartment resection in the surgical treatment of cervical cancer is both safe and feasible. Utilizing robotic technology enables more precise and refined surgical outcomes. Combining embryonic compartment-based radical hysterectomy with the principles of membrane anatomy can standardize and optimize the surgical process, helping surgeons master radical hysterectomy more quickly and effectively.
根治性子宫切除术已成为早期宫颈癌的标准治疗方法。尽管人们为使不同肿瘤浸润程度的根治性子宫切除术技术标准化付出了诸多努力，但成效并不一致。全苗勒管腔室切除术（TMCR）是一种基于个体发生腔室的肿瘤外科手术，最初由赫克尔教授为开放手术所开发，它为所有局部局限肿瘤患者提供了一种标准化方法。该方法有望在保持可接受并发症发生率的同时实现彻底的肿瘤清除。此外，与开放手术相比，机器人辅助手术可能进一步降低发病率。在此背景下，我们详细逐步描述了用于宫颈癌的机器人辅助全苗勒管腔室切除术（R-TMCR），并展示了来自20例患者队列的可行性数据。
对20例IA1 - IB2期宫颈癌患者进行了机器人辅助的苗勒管胚胎腔室切除术。精心记录并分析了手术时长、术中失血量和术后并发症发生率等关键指标。
手术时长在185至500分钟之间，术中失血量在5毫升至300毫升之间。术后血红蛋白水平较术前值下降了15至40克/升。值得注意的是，没有出现需要转为开放手术的情况，也没有发生术中并发症。术后并发症发生率为0%。在平均为期18个月的随访期内，未观察到宫颈癌的局部区域复发，在此期间也没有因宫颈癌导致的死亡病例。
机器人苗勒管腔室切除术在宫颈癌手术治疗中的应用是安全可行的。利用机器人技术可实现更精确、精细的手术效果。将基于胚胎腔室的根治性子宫切除术与膜解剖学原理相结合，能够使手术过程标准化并优化，帮助外科医生更快、更有效地掌握根治性子宫切除术。
