Largest studies of robotic-assisted surgery for gynecologic procedures find fewer complications

Tuesday, November 11, 2008 — Doctors at the University of North Carolina at Chapel Hill School of Medicine have shown in the largest groups of patients to date that robotically-assisted surgery provides superior short-term outcomes for two gynecologic procedures.

Since 2000, hundreds of hospitals worldwide have used robotic surgical systems to equip surgeons with enhanced vision and dexterity when performing minimally invasive procedures. Now doctors at the University of North Carolina at Chapel Hill School of Medicine have shown in the largest groups of patients to date that robotically-assisted surgery provides superior short-term outcomes for two gynecologic procedures.

“The first step when introducing new technology is to show outcomes that are at least equivalent to those from the current gold standard procedure,” said John Boggess, M.D., associate professor of obstetrics and gynecology. “In two studies with significant numbers of patients, we not only show robotics is equivalent to open surgery, but we actually show improvement.”

Boggess and colleagues report that patients who underwent robotic-assisted radical hysterectomy for cervical cancer or robotic-assisted endometrial cancer staging experienced less blood loss and shorter hospital stays than patients who had the same procedures performed in the traditional, open manner or via laparoscopy (a minimally invasive method performed without robotic assistance).

The findings are published in two separate studies in the October 2008 issue of the American Journal of Obstetrics and Gynecology.

Both of the studies tracked outcomes for these robotic-assisted procedures in the largest group of patients to date. The UNC surgeons followed 103 patients who had robotic-assisted endometrial cancer staging, and 51 patients who underwent radical hysterectomy for cervical cancer.

Christina Spence of Knightdale, N.C., was diagnosed with uterine cancer. In November of 2007 the 54-year-old underwent robotic-assisted radical hysterectomy at UNC during which a number of lymph nodes were removed. Spence said she was “amazed” that the level of pain she expected to experience after the surgery, “just wasn’t there….”

In addition to causing fewer complications, the robotic procedures yielded surgical proficiency that was at least as good as that of traditional procedures. For instance, with robotic-assisted endometrial cancer staging, surgeons dissected a larger number of lymph nodes than with open or laparoscopic procedures. “We believe that reflects the increased visualization and 3-dimensional magnification of the robot, and the dexterity of the instruments,” Boggess said.

Removing a larger number of lymph nodes is associated with longer survival rates. Boggess and colleagues will follow patients to determine whether robotic procedures actually improve long-term outcomes.

Today’s robotic surgical systems are not cheap; a base system costs more than $1 million. But if robotics help surgeons perform procedures that are just as thorough as open surgeries but that result in fewer complications and shorter hospital stays, robotics could yield a cost savings in the long run, Boggess said.

But those benefits will only be realized if robotic tools are placed in the hands of skilled surgeons. “The robot doesn’t eliminate human error, but it reduces it by providing a better set of tools,” Boggess said.

In addition to Boggess, authors in the division of gynecologic oncology, department of obstetrics and gynecology at UNC are associate professor Paola A. Gehrig, M.D., clinical fellows Leigh Cantrell, M.D. and Aaron Shafer, M.D., and Distinguished Professor and division director Wesley C. Fowler, M.D.

Additional authors are former fellows Mildred Ridgway, M.D. (now of the University of Mississippi Medical Center), and Elizabeth N. Skinner M.D., (now of Forsyth Medical Center in Winston-Salem, N.C.)

Boggess and other surgeons shared their expertise in robotic-assisted procedures at the Second Annual International Gynecologic Oncology Robotics Symposium in Chapel Hill, November 9-11, 2008.

Note: John Boggess can be reached at (919) 966-5996 or jboggess@med.unc.edu.

School of Medicine contacts: Stephanie Crayton, (919) 966-2860, scrayton@unch.unc.edu or Clinton Colmenares, (919) 966-8757, ccolmena@unch.unc.edu

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