| The present study aimed to explore the clinical application of Davinci robotic surgery system in the treatment of cervical cancer.Part I:The clinical effectiveness of Davinci robotic cervical cancer radical surgery compared to traditional approachesObjectives:To evaluate the clinical effectiveness of robotic surgery compared with traditional surgery procedures by a systematic review and Meta-analysis. Methods:A computerized literature search was conducted and the clinical outcomes were compared among different groups, including length of hospital stay(LOS), blood loss(BL) and transfusion rates(BT), incidence of complications, number of pelvic lymph node.Results:A total of 19 investigations were included. Compared to laparoscopic or open surgeries,the LOS was shorter (SMD:-3.49,95%CI:-4.09,-2.08;P<0.05), SL was less(SMD:-1.69,95%CI:-1.93,-1.45; P<0.05), complications(pooled OR:2.82, 95%CI:1.70,4.69;P<0.05) and BT rate(pooled OR:7.77,95%CI:2.17,27.79;.P<0.05) were lower in Davinci group. Conclusion:The robotic radical hysterectomy and the pelvic lymphadenectomy are feasible and safe for these patients with cervical cancer.Part II:Clinical comparative study of the Davinci robotic system compared with triditional surgery in cervical cancer patientsObjective:To compare the clinical outcomes among the Davinci robotic system, open, laparoscopic and transvaginal combined laparoscopic cervical cancer radical surgeries.Method:We retrospectively analyzed 360 cases of cervical cancer patients revived treatments during 2009.5 2014.12 in our hospital (100 cases,90 cases,100 cases and 70 cases respectively for Davinci, laparoscopic,open and transvaginal combined laparoscopic cervical cancer radical surgeries).All the patients received radical hysterectomy and pelvic lymphadenectomy. Clinical outcomes among the four groups were compared. Results:No statistical difference,concerning the age, body mass index, FIGO staging, pathological type, history of previous pelvic surgery,were found among groups. Compared with open and transvaginal combined laparoscopic cervical cancer radical surgeries group, the Davinci and laparoscopic group had significantly less BL(99.7±64ml,164.4±130 ml vs.590±280 ml, P<0.05), shorter LOS(9.2±3.7 d,11.2 ±4.9d vs.14.5 ± 10.7d, P<0.05) and lower BT rate (2%,23,3%vs.51%, P<0.01). No significant differences were found among four groups about the numbers of lymph node excised in surgery(P>0.05). Conclusion:Davinci robot cervical cancer radical surgery.is a kind of safe and effective minimally invasive operation method.Part III:Preliminary research of cytokine changes in preioperation of cervical cancer radiacal surgeryObjective:To compare the levels of the damage and repair related serum cytokines among the Davinci robot group,the laparotomy group, and the open group.Methods: Fifteen patients received treatment in our department (from 2014-09 to 2015-01) were enrolled in the present study. Damage and repair related cytokines levels such as IL-6, IL-10, C-reactive protein in the perioperative serum were exmined.The serum CRP level changes of the cervical cancer patients received treatment in our department (from 2010-05 to 2014-12)were retrospective studied. Results:The levels of the C-reactive protein in postoperative serum in all the three groups increased after operation. The level of the CRP was significantly lower in the Davinci robot group and the laparoscopic surgery group than open surgery group on the postopration day of P1 and P7 (p=0.0015 and p=0.0063). However, no significant difference was found between the Davinci robot group and the laparoscopic surgery group. Prospective study showed that the levels of IL-6、IL-8、IL-10、TNF-a in all the three groups increased after operation. The level of the IL-6、IL-8、IL-10、TNF-a was significantly lower in the Davinci robot group and the laparoscopic surgery group than open surgery group.Conclusion:The Davinci robot and the laparoscopic surgery have less surgical trauma on body than open surgery. |
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