["Learning curve" robotic radical hysterectomy compared to standardized laparoscopy assisted radical vaginal and open radical hysterectomy].

OBJECTIVE: To compare intraoperative, pathologic and postoperative outcomes of "learning curve" robotic radical hysterectomy (RRH) with laparoscopy assisted radical vaginal hysterectomy (LARVH) and abdominal radical hysterectomy (ARH) in patients with early stage cervical carcinoma. DESIGN: Comparative study. SETTING: Department of Obstetrics and Gynecology, University Hospital, Olomouc. METHODS: The first twenty patients with cervical cancer stages IA2-IIA underwent RRH and were compared with previous twenty LARVH and ARH cases. The procedures were performed at University Hospital Olomouc, Czech Republic between 2004 and 2011. RESULTS: There were no differences between groups for age, body mass index, tumor histology, number of nodes removed or preoperative hemoglobin levels. The median theatre time in the learning period for the robot procedure was reduced from 400 min to less than 223 min and compared well to the 215 min for an open procedure. We found differences between the pre- and postoperative hemoglobin levels (RRH, 14.9 ±7 .6; LARVH, 23.0 ± 8.5; ARH, 28.0 ± 12.4). This difference was statistically significant in favor of RRH group ( p= 0.0012). Mean length of stay was significantly shorter for the RRH group (7.2 versus 8.8 days,p = 0.0005). Mean pelvic lymph node count was similar in the three groups. None of the robotic or laparoscopic procedures required conversion to laparotomy. The differences in major operative complications between the two groups were not significant. CONCLUSION: Based on our experience, robotic radical hysterectomy showed better results than traditional laparoscopically assisted radical vaginal hysterectomy in early stage cervical carcinoma cases. Introduction of this new technique requires a learning curve of less than 20 cases that will reduce the operating time to a level comparable to open surger.