Clinical comparison of robotic, laparoscopic, and open hysterectomy procedures for endometrial cancer patients

The goal of this study was to compare outcomes for robotic, laparoscopic, and open hysterectomy procedures for endometrial cancer as well as to investigate whether specific patient demographic, comorbidity, and severity variables were associated with the type of hysterectomy performed. A retrospective review was conducted of hysterectomy procedures for patients discharged from October 1, 2008 and September 30, 2012. Preoperative characteristics included age, BMI, number of past abdominal surgeries, and comorbidities. Intraoperative and postoperative characteristics included uterine weight and diameter, American Society of Anesthesiologists physical status classification, lymph-vascular space involvement, FIGO stage and tumor grade. Outcomes included operative time, estimated blood loss, length of stay, conversion to open, other intraoperative and postoperative complications, readmissions within 30 days and lymph node yield. The robotic and laparoscopic cohorts show no significant differences in patient or tumor characteristics, while the open cases represent patients with increased complexity. In general, laparoscopic cases were shorter than robotic and open cases. Laparoscopic cases had fewer conversions to open than robotic cases. Robotic and open cases had significantly higher lymph node yield than laparoscopic cases. The reduction in surgical time and conversion rates in the laparoscopic cohort may be related to the reduction in node dissection performed.