A Prospective Randomized Trials Of DaVinci Robotic-assisted Versus Traditional Laparoscopic Surgery For Endometrial Cancer

Objective:To explore the clinical value and learning curve of Da Vinci Robotic surgery system in surgical staging endometrial cancer comparing traditional laparoscopic surgery by a prospective randomized controlled trials.Method:Applying the prospective single-center randomized controlled method.Patients were randomized into 2 groups:DaVinci robotic-assisted group and traditional laparoscopic group.Between August 2016,and January 2018,A total of 83 patients were randomly assigned to undergo either DaVinci robotic-assisted(n=38)and traditional laparoscopic surgery(n=45)in the First Affiliated Hospital of Guangxi Medical University.Surgical outcomes such as opertive time,blood loss,number of lymph nodes retrieved,complications,catheterization time,time of drainage tube removal,anal exhaust time were analyzed together with length of postoperative stay,postoperative pain,and surgery cost per patient.The learning curve was evaluated using the cumulative sum(CUSUM)method.Results:1.Operative time was significantly shorter in the robotic-assisted laparoscopic group(206.6±45.99min vs.244.9±50.02min,p=0.001);The blood loss was lower and length of postoperative stay was shorter in the robotic-assisted laparoscopic group(96.3±86.19ml vs.147.6±114.12ml,p=0.026)and(7.3±2.54d vs.8.5±2.79d,p=0.035).The anal exhaust time was shorter and less postoperative pain in the robotic-assisted laparoscopic group(1.9±0.34d vs.2.3±0.46d,p=0.000);However,robotic-assisted laparoscopic surgery was more costly than laparoscopic surgery(28563±6470y vs.11863±2593y,p=0.000).For the time of drainage tube removal,robotic group were longer than laparoscopic group(5.1±2.16d vs.4.2±1.5d,p=0.032).There was no statistical difference in complications,catheterization time between the groups;and both number of lymph nodes retrieved.2.For overweight patients(BMI?24Kg/m~2),the Da Vinci robotic-assisted group demonstrated significant advantages with respect to operative times(202.1±51.71min vs.241.5±43.06min,p=0.018);anal exhaust time(1.9±0.24d vs.2.3±0.45d,p=0.012),and less postoperative pain in the robotic-assisted laparoscopic group.3.The CUSUM learning curve consisted of two distinct phases:learning phase(ascent curve)and master phases(decline curve).At the appearance of the turning point,the corresponding cases was the the least cases to master this skill.The learning curve of the operative time needed 21cases,blood loss needed 14 cases,and length of postoperative stay needed21cases,catheterization time needed 24,time of drainage tube removal needed 21 cases.The learning curve in the treatment of endometrial cancer for Da Vinci robotic surgical procedures should be 24 cases.Conclusion:1?DaVinci Robotic surgery offers an effective and safe alternative in the surgical treatment of endometrial cancer,Especially in treating overweight and obese patients,and better results than with traditional laparoscopic surgical staging of endometrial cancer.But the cost of robot surgery is relatively high,which patients need to measure their economic ability to choose the appropriate surgical method.2?From our data,it is considered that the learning curve of DaVinci robotic surgery for endometrial cancer staging is 24 cases for an experience laparoscopic surgeon.The learning curve is shorter than traditional laparoscopic surgery.