To review peri-operative outcomes of patients with adnexal malignancies who underwent robotic-assisted laparoscopic surgical (RALS) staging procedures. Retrospective analyses of 59 patients with a malignant "adnexal mass" diagnosed at robotic surgery or incompletely staged ovarian cancer undergoing robotic staging. A tertiary gynecologic oncology referral center with a fellowship training program. All cases with a pre-operative diagnosis of "adnexal mass" subsequently proven to be malignant or cases of "unstaged ovarian cancer" undergoing robotic staging identified in a robotic surgery database (10/06 to 01/11). RALS utilizing da Vinci® Surgical System. Abstracted data included demographics, peri-operative outcomes, and complications for 59 cases (36 primary surgery, 23 staging surgery with prior diagnosis). Mean age was 50 ± 16 years (range 19-89), BMI 28 ± 6 kg/m2. Pre-op CA-125 for primary cases was 48 ± 39 U/mL, and tumor size 6 ± 3 cm (range 1-11). Pathology for staged malignancies were: 22 epithelial ovarian cancer, 20 low-malignant-potential (LMP), 9 granulosa cell, 7 fallopian tube, and 1 germ cell. All patients had washings, peritoneal biopsies, and omentectomy. 46 patients had lymphadenectomy (45 pelvic, 26 pelvic+aortic, 16 unilateral). Mean pelvic node counts were 11 ± 7 (range 2-33) and aortic node counts were 8 ± 6 (range 1-22). Robotic surgery upstaged only 1 (5%) of LMP and 9 (15.3%) of non-LMP cases (IIC = 5, IIIB = 1, and IIIC = 4). Mean operative time was 147 ± 46 min and estimated blood loss 81 ± 82 mL. Mean hospital length-of-stay was 1.0 ± 0.2 days (range 0.5-5.0). There were two laparotomy conversions, one transfusion, 3 (5.1%) major post-operative complications (transverse colo-vaginal fistula, PTE post-op day-18, and laparotomy wound infection) and five cases of transient anterior thigh paresthesias. Consistent with reports of RALS for cervical and endometrial cancers, surgical staging of apparent early-stage ovarian cancer was associated with low morbidity, few laparotomy conversions, and a 23% upstaging in non-LMP cases.

Study ObjectiveTo perform a 4-year annual comparison of peri-operative outcomes for patients with endometrial cancer (EC) treated with robotic-assisted laparoscopic hysterectomy (RALH) and lymphadenectomy.DesignIRB-approved retrospective analyses of clinical-pathologic factors and surgical outcomes data from 391 patients with EC who underwent successful RALH with lymphadenectomy from 07/2006 to 06/2010.SettingA tertiary gynecologic oncology referral center with a fellowship training program.PatientsAnnual comparison of all EC cases (n=391) treated with RALH/lymphadenectomy at a single institution.InterventionRALH/lymphadenectomy utilizing da Vinci® Surgical System.Measurements and Main ResultsAbstracted data included demographics, clinical-pathologic and peri-operative outcomes, and complications for 391 EC cases. 222(56.8%) of RALH cases had complete pelvic/aortic lymphadenectomy (PAL) and 169 had only pelvic lymphadenectomy (PL). 42, 79, 108, and 162 RALH cases were performed in years 1, 2, 3, and 4, respectively. Between year 1 vs. 4, mean age increased (57.4±10.7 vs. 63.8±10.6; p<0.01), but hospital length-of-stay and estimated blood loss did not change significantly (1.0±0.4 vs. 1.4±1.8 days, and 94±59 vs. 79±59 mL). Mean BMI increased (28.2±7.1 vs. 31.7±7.4 kg/m2, p<0.01). Operative time (OT) decreased (173±56 vs. 148±34 min, p<0.001), total lymph node (LN) counts increased (16.9±11.8 vs. 24.2±10.9, p<0.001) and aortic LN increased (6.6±5.0 vs. 11.0±6.7, p<0.001) by years 1 vs. 4. For PAL cases only, OT was 185, 181, 185, and 165 min, and node counts were 21, 25, 27, 29 for years 1-4, respectively. 58.3% of RALH cases were grade 1 and LN metastasis were identified in 8.2% cases. Surgical Stage II to IV disease was present in 90(23%) of RALH cases. There were 30(7.7%) complications and only 2(0.5%) transfusions.ConclusionThis 4-year comparative analysis of RALH cases for EC reveals a significant reduction in OT, despite an increase in BMI, age, and lymph node retrieval. A reduction in OT for PAL cases was recognized in the year-4. Study ObjectiveTo perform a 4-year annual comparison of peri-operative outcomes for patients with endometrial cancer (EC) treated with robotic-assisted laparoscopic hysterectomy (RALH) and lymphadenectomy. To perform a 4-year annual comparison of peri-operative outcomes for patients with endometrial cancer (EC) treated with robotic-assisted laparoscopic hysterectomy (RALH) and lymphadenectomy. DesignIRB-approved retrospective analyses of clinical-pathologic factors and surgical outcomes data from 391 patients with EC who underwent successful RALH with lymphadenectomy from 07/2006 to 06/2010. IRB-approved retrospective analyses of clinical-pathologic factors and surgical outcomes data from 391 patients with EC who underwent successful RALH with lymphadenectomy from 07/2006 to 06/2010. SettingA tertiary gynecologic oncology referral center with a fellowship training program. A tertiary gynecologic oncology referral center with a fellowship training program. PatientsAnnual comparison of all EC cases (n=391) treated with RALH/lymphadenectomy at a single institution. Annual comparison of all EC cases (n=391) treated with RALH/lymphadenectomy at a single institution. InterventionRALH/lymphadenectomy utilizing da Vinci® Surgical System. RALH/lymphadenectomy utilizing da Vinci® Surgical System. Measurements and Main ResultsAbstracted data included demographics, clinical-pathologic and peri-operative outcomes, and complications for 391 EC cases. 222(56.8%) of RALH cases had complete pelvic/aortic lymphadenectomy (PAL) and 169 had only pelvic lymphadenectomy (PL). 42, 79, 108, and 162 RALH cases were performed in years 1, 2, 3, and 4, respectively. Between year 1 vs. 4, mean age increased (57.4±10.7 vs. 63.8±10.6; p<0.01), but hospital length-of-stay and estimated blood loss did not change significantly (1.0±0.4 vs. 1.4±1.8 days, and 94±59 vs. 79±59 mL). Mean BMI increased (28.2±7.1 vs. 31.7±7.4 kg/m2, p<0.01). Operative time (OT) decreased (173±56 vs. 148±34 min, p<0.001), total lymph node (LN) counts increased (16.9±11.8 vs. 24.2±10.9, p<0.001) and aortic LN increased (6.6±5.0 vs. 11.0±6.7, p<0.001) by years 1 vs. 4. For PAL cases only, OT was 185, 181, 185, and 165 min, and node counts were 21, 25, 27, 29 for years 1-4, respectively. 58.3% of RALH cases were grade 1 and LN metastasis were identified in 8.2% cases. Surgical Stage II to IV disease was present in 90(23%) of RALH cases. There were 30(7.7%) complications and only 2(0.5%) transfusions. Abstracted data included demographics, clinical-pathologic and peri-operative outcomes, and complications for 391 EC cases. 222(56.8%) of RALH cases had complete pelvic/aortic lymphadenectomy (PAL) and 169 had only pelvic lymphadenectomy (PL). 42, 79, 108, and 162 RALH cases were performed in years 1, 2, 3, and 4, respectively. Between year 1 vs. 4, mean age increased (57.4±10.7 vs. 63.8±10.6; p<0.01), but hospital length-of-stay and estimated blood loss did not change significantly (1.0±0.4 vs. 1.4±1.8 days, and 94±59 vs. 79±59 mL). Mean BMI increased (28.2±7.1 vs. 31.7±7.4 kg/m2, p<0.01). Operative time (OT) decreased (173±56 vs. 148±34 min, p<0.001), total lymph node (LN) counts increased (16.9±11.8 vs. 24.2±10.9, p<0.001) and aortic LN increased (6.6±5.0 vs. 11.0±6.7, p<0.001) by years 1 vs. 4. For PAL cases only, OT was 185, 181, 185, and 165 min, and node counts were 21, 25, 27, 29 for years 1-4, respectively. 58.3% of RALH cases were grade 1 and LN metastasis were identified in 8.2% cases. Surgical Stage II to IV disease was present in 90(23%) of RALH cases. There were 30(7.7%) complications and only 2(0.5%) transfusions. ConclusionThis 4-year comparative analysis of RALH cases for EC reveals a significant reduction in OT, despite an increase in BMI, age, and lymph node retrieval. A reduction in OT for PAL cases was recognized in the year-4. This 4-year comparative analysis of RALH cases for EC reveals a significant reduction in OT, despite an increase in BMI, age, and lymph node retrieval. A reduction in OT for PAL cases was recognized in the year-4.

Study ObjectiveTo describe feasibility and surgical outcomes of robotic-assisted extra-fascial hysterectomy with bilateral salpingo-oophorectomy (BSO) with common and para-aortic lymphadenectomy (PAL) following whole pelvic radiation therapy (WPRT) with concurrent chemotherapy for the treatment of IB-2 cervical carcinoma.DesignA retrospective review of nine patients undergoing robotic-assisted laparoscopic hysterectomy (RALH) with BSO following WPRT between June 2008 and February 2011.SettingA single tertiary gynecologic oncology referral center with fellowship training program.PatientsNine patients with clinical stage IB-2 cervical carcinoma.InterventionAll patients had pre-treatment PET or CT scans without extra-pelvic disease. Patients underwent 4500-5040 cGy of WPRT with concurrent platinum-based chemotherapy followed by HDR brachytherapy in three fractions, delivering 1500 cGy. RALH and BSO with PAL was completed 6-8 weeks after radiation.Measurements and Main ResultsThe mean tumor size was 5.7 ± 1.1 cm. The mean age was 45.8 ± 7.2 years, BMI 24.2 ± 4.4 kg/m2. The mean operative time was 119 ± 34 min, estimated blood loss was 69 ± 30 mL. The mean lymph node yield was 8.2 ± 3.0. All patients were discharged on post-operative day-1. There was no vaginal cuff dehiscence. Two patients developed cuff granulation tissue which resolved. There have been no major complications including gastrointestinal and genitourinary fistula. In this short follow-up, we have seen normal sexual function with no vaginal stenosis.ConclusionThe NCCN treatment guideline of pre-operative WPRT and concurrent chemotherapy with brachytherapy followed by extra-fascial hysterectomy for IB-2 cervical carcinoma is feasible with robotic surgery. Surgery 6-8 weeks after radiation appears safe without surgical morbidity. Study ObjectiveTo describe feasibility and surgical outcomes of robotic-assisted extra-fascial hysterectomy with bilateral salpingo-oophorectomy (BSO) with common and para-aortic lymphadenectomy (PAL) following whole pelvic radiation therapy (WPRT) with concurrent chemotherapy for the treatment of IB-2 cervical carcinoma. To describe feasibility and surgical outcomes of robotic-assisted extra-fascial hysterectomy with bilateral salpingo-oophorectomy (BSO) with common and para-aortic lymphadenectomy (PAL) following whole pelvic radiation therapy (WPRT) with concurrent chemotherapy for the treatment of IB-2 cervical carcinoma. DesignA retrospective review of nine patients undergoing robotic-assisted laparoscopic hysterectomy (RALH) with BSO following WPRT between June 2008 and February 2011. A retrospective review of nine patients undergoing robotic-assisted laparoscopic hysterectomy (RALH) with BSO following WPRT between June 2008 and February 2011. SettingA single tertiary gynecologic oncology referral center with fellowship training program. A single tertiary gynecologic oncology referral center with fellowship training program. PatientsNine patients with clinical stage IB-2 cervical carcinoma. Nine patients with clinical stage IB-2 cervical carcinoma. InterventionAll patients had pre-treatment PET or CT scans without extra-pelvic disease. Patients underwent 4500-5040 cGy of WPRT with concurrent platinum-based chemotherapy followed by HDR brachytherapy in three fractions, delivering 1500 cGy. RALH and BSO with PAL was completed 6-8 weeks after radiation. All patients had pre-treatment PET or CT scans without extra-pelvic disease. Patients underwent 4500-5040 cGy of WPRT with concurrent platinum-based chemotherapy followed by HDR brachytherapy in three fractions, delivering 1500 cGy. RALH and BSO with PAL was completed 6-8 weeks after radiation. Measurements and Main ResultsThe mean tumor size was 5.7 ± 1.1 cm. The mean age was 45.8 ± 7.2 years, BMI 24.2 ± 4.4 kg/m2. The mean operative time was 119 ± 34 min, estimated blood loss was 69 ± 30 mL. The mean lymph node yield was 8.2 ± 3.0. All patients were discharged on post-operative day-1. There was no vaginal cuff dehiscence. Two patients developed cuff granulation tissue which resolved. There have been no major complications including gastrointestinal and genitourinary fistula. In this short follow-up, we have seen normal sexual function with no vaginal stenosis. The mean tumor size was 5.7 ± 1.1 cm. The mean age was 45.8 ± 7.2 years, BMI 24.2 ± 4.4 kg/m2. The mean operative time was 119 ± 34 min, estimated blood loss was 69 ± 30 mL. The mean lymph node yield was 8.2 ± 3.0. All patients were discharged on post-operative day-1. There was no vaginal cuff dehiscence. Two patients developed cuff granulation tissue which resolved. There have been no major complications including gastrointestinal and genitourinary fistula. In this short follow-up, we have seen normal sexual function with no vaginal stenosis. ConclusionThe NCCN treatment guideline of pre-operative WPRT and concurrent chemotherapy with brachytherapy followed by extra-fascial hysterectomy for IB-2 cervical carcinoma is feasible with robotic surgery. Surgery 6-8 weeks after radiation appears safe without surgical morbidity. The NCCN treatment guideline of pre-operative WPRT and concurrent chemotherapy with brachytherapy followed by extra-fascial hysterectomy for IB-2 cervical carcinoma is feasible with robotic surgery. Surgery 6-8 weeks after radiation appears safe without surgical morbidity.