Objectives To evaluate the technical feasibility and safety of Robotic assisted Para aortic lymphadenectomy in comparison with Open surgery in terms of adequacy of staging, blood loss,lymph node harvest, hospital stay and complications.
Methods A randomized prospective study was performed which included 180 patients diagnosed with endometrial carcinoma who were divided into two groups one open and other robotic. All patients underwent Type I Pan Hysterectomy + B/L Pelvic lymphadenectomy. The high risk patients (FIGO grade 3, Tumor > 2cm, pelvic node positive and >50% myoinvasion) were taken up for para aortic lymphadenectomy. The Para-Aortic node dissection was performedupto renal veins. The split and roll technique was used to perform the pre caval and pre aortic lymphadenectomy.
Results Of 180 patients, 113 had high risk endometrial cancer (open 58 and Robotic 55).The average blood loss in open arm was 134.6ml vs 41.2ml in robotic arm. In open surgery on average 11.6 nodes were harvested when compared to 17.5 nodes in robotic arm. Duration of hospital stay for open group was 5.54 days vs 1.94 days for robotic arm. None of the patients in either arm had any major intra-operative or post-operative complications.23 patients in the open arm had prolonged ileus while 4 patients had ileus in robotic arm. 7 patients in open arm developed wound infection.
Conclusions This study showed that robotic assisted para-aortic lymphadenectomy had equal oncologic outcome as compared to open technique. Minimal blood loss and less pain helped in shorter hospital stay and early return to normal activities.
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