Re: Role of robot-assisted laparoscopy in adjuvant surgery for locally advanced cervical cancer (EJSO 2010; 36(4):409-13) by Lambaudie e et al.

摘要

Concerning robotic assistance we are totally agree with Dr Vizza: from the past 10 years, it constitutes the best evolution of minimal invasive surgery (less blood loss, less complications, less conversion to open, shorter hospital stay,...) and its potential in gynecological surgery and particularly oncological indications is underestimated.The main objective of our task is to show the faisibility of robotic assisted laparoscopy hysterectomy (extrafacial or radical) after concomitant chemo radiation treatment (CRT) and systematic brachytherapy. And it is feasible without difference compared to laparoscopy and open: so the conclusion might be, if you have to do adjuvant surgery, it is possible, and easier in our experience, with the robot. But as underlined, some bias is present because it is a retrospective study in 2 oncological centers, with 4 different surgeons.The question of the type of surgery after CRT is totally different and its interest is debated. As cited by Dr Vizza, the morbidity of radical hysterectomy is very high. But these post operative complications (often urinary morbidity) must not be compared with the publications of Boggess and Kho, because their patients have not been managed with 45 Gy of external beam and 15 Gy of brachytherapy before surgery...