Robot assisted laparoscopy in radical hysterectomy for early uterine cervical cancer: Feasibility and role in preservation of pelvic nerve fibres [Faisabilité et intérêt de préserver les fibres nerveuses pelviennes au cours d'hystérectomies élargies par c?lioscopie robot-assistée pour cancer du col utérin précoce]

摘要

Objective: To study the feasibility of preservation of the pelvic nerve plexuses in robot-assisted radical hysterectomy and potential reduction in urinary tract morbidity. Methods: This study was carried out between February 2008 and August 2010 in two referral centres for gynaecological cancer. All the patients underwent robot-assisted radical hysterectomy. This was either primary surgery with pelvic clearance for a cervical cancer of less than 2 cm or repeat surgery after negative pelvic node clearance and vaginal brachytherapy for cervical cancer measuring 2 to 4 cm. During each procedure, we tried to identify and preserve the pelvic nerve plexuses (nerve sparing), which are partly responsible for normal bladder function. The urinary catheter was routinely removed on the second post-surgical day. Residual urine volume was recorded routinely after each of the first two spontaneous bladder voidings. Results: Fifty patients underwent robot-assisted radical hysterectomy during the period of this study. Identification and anatomical preservation of the pelvic nerve fibres was achieved in each case. It was not necessary on any occasion to convert the procedure into a laparoscopy or laparotomy. The median age of the patients was 45 years (33-68), and the median body mass index was 23.8 (17.7-39.4). FIGO stages were IA1 in 2 patients (4%), IB1 in 41 (82%), IIA in 1 patient (2%) and IIB in the remaining 6 (12%). The mean size of the cervical tumour was 20 mm (4-40). Twenty-one patients (42%) had pre-operative brachytherapy. The mean duration of surgery was 298 minutes (135-405), estimated blood loss 108 ml (30-1,500) and the number of pelvic nodes removed 17.2 (4-41). The median hospital stay was 4.2 days. The complication rate was 42%. We recorded dysuria in 12% of the cases. Conclusion: With robotic assistance during radical hysterectomy for uterine cervical cancer of less than 4 cm, it seems to be possible to preserve the nerve fibres of the pelvic plexuses, even after brachytherapy. More than 88% of the patients had no post-micturition bladder residue (less than 100 ml) after the first postoperative spontaneous voiding.