research day - University of Toronto Department of Obstetrics and ...

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ABSTRACT #P-F5
OUTCOMES IN ROBOTIC-ASSISTED SURGERY FOR GYNAECOLOGIC ONCOLOGY
Lilian T Gien [F], Barry Rosen, Marcus Bernardini
Division of Gynecologic Oncology, Princess Margaret Hospital, University of Toronto
Objective: The purpose of this study was to analyze the perioperative and quality of life outcomes
in patients with robotic-assisted surgery for gynaecologic oncology.
Methods: In this prospective observational study, patients had robotic-assisted surgery consisting
of a hysterectomy and bilateral salpingo-oophorectomy (HBSO) +/- omentectomy, pelvic and paraaortic
node dissection between December 1, 2008 and February 23, 2009. All cases were done by
two gynaecologic oncologists at a single institution. Data collection included operative time,
estimated blood loss, intra- and post-operative complications, lymph node counts, and length of
stay. The median operative time for the first half of patients was compared to that of the second
half. Post-operative questionnaires were completed to evaluate pain control, return to normal
activity, and quality of life. Statistical analysis included the Mann-Whitney U test.
Results: Twenty gynaecologic oncology patients had robotic-assisted surgery. Median age was
63 years and median BMI was 32.7 kg/m 2 (range 20.8-57.9 kg/m 2 ). 85% had a malignancy,
including endometrial, cervical or ovarian carcinoma. 50% of cases included pelvic and paraaortic
lymphadenectomy; median lymph node count was 20. The median operative time was 203
mins (range 101-355 mins). Among those with HBSO +/- omentectomy, operative time
significantly decreased between the first half and second half of patients (201 mins vs 124 mins,
p=0.043). Conversion to a vaginal approach occurred in two patients. Five patients had minor
postoperative complications such as UTI or genitofemoral nerve injury. Median estimated blood
loss was 80 cc and median length of stay was 1 day. By 3 weeks after surgery, the majority of
patients reported minimal to no pain, a return to normal activity, and a good quality of life.
Conclusion: Robotic-assisted surgery is feasible in gynaecologic oncology patients who require
surgical staging, and is associated with minimal blood loss, short hospital stay, and excellent
patient recovery. As a tool for promoting minimally invasive surgery, increasing experience with
the Da Vinci robotic system with even a small number of cases leads to a significant decrease in
operative time.