The “Medical Cost” of Robot-Assisted Laparoscopic Surgery in Endometrial Cancer in Terms of Anesthesia Comparison with Traditional Laparoscopic Surgery

Year 2023, Volume: 4 Issue: 3, 114 - 119, 21.09.2023

Nalan Saygı Emir Güneş Özlem Yıldız

https://doi.org/10.56766/ntms.1264292

Abstract

Objective :Minimally invasive surgeries have important advantages such as lower morbidity, shorter hospital stay, and earlier return to routine life. Robot-assisted laparoscopic surgery (RALS) plays a leading role in the development process of minimally invasive surgery. In this study, we compared patients with endometrial cancer who were operated with RALS and traditional laparoscopic surgery (TLS) methods in terms of processes related to anesthesia, such as peroperative fluid management and transfusion requirement, analgesic strategies, postoperative complications, duration of post-anesthesia care unit (PACU) and hospital stay
Materials and Methods: Patients with American Society of Anaesthesiologists (ASA) scores II-III, over the age of 18, who were operated for endometrial cancer by TLS or RALS methods between January 2020 and March 2022 were included in the study. Patients age, ASA score, duration of surgery, peroperative fluid management, transfusion requirement, urine output, bleeding, postoperative Visual Analogue Scale (VAS) scores, the PACU admission were obtained from the standard anesthesia record form and preoperative and postoperative hemoglobin (Hb) values, length of hospital stay were obtained from the electronic database of the hospital.
Results: Intravenous fluid input, bleeding and urine output during the operation were statistically lower in group RALS. While there was no difference between the preoperative Hb values of the two groups, the postoperative Hb values were significantly lower in the TLS group. Perioperative bleeding and fluid replacement are lesser and the hospital stay is shorter in RALS.
Conclusion: TLS and RALS, which are minimally invasive surgical methods, are used in the treatment of endometrial cancer. The idea that RALS is more costly than TLS should be reconsidered, as RALS reduces costs with less perioperative bleeding and fluid replacement and shorter hospital stay

Keywords

anesthesia, endometrial cancer, laparoscopic surgery, postoperative pain, robot assisted laparoscopic surgery

References

• 1. WHO Classification of tumors of the female reproductive organs, 4, Kurman RJ, Carcangiu ML, Herrington CS, Young RH (Eds), World Health Organization, 2014. p.126, 150.
• 2. Pecorelli S. revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009; 105:103.
• 3. Janda M, Gebski V, Davies LC et al. The Effect of Total Laparoscopic Hysterectomy and Total Abdominal Hysterectomy on Disease-Free Survival in Women with Stage I Endometrial Cancer: A Randomized Clinical Study. JAMA. 2017; 317:1224.
• 4. Wilson EB. The evolution of robotic general surgery. Scan J Surg. 2009; 98:125-29.
• 5. Wright JD, Burke WM, Wilde ET et al. Comparative efficacy of robotic and laparoscopic hysterectomy for endometrial cancer. J Clin Oncol. 2012; 30:783.
• 6. Agarwal R, Rajanbabu A, Unnikrishnan UG. Retrospective evaluation and cost comparison of perioperative drug use in robotic and open surgery for endometrial cancer. J Robot Surgeon. 2018; 12(4):665-72.
• 7. Lindfors A, Åkesson Å, Staf C, Sjöli P, Sundfeldt K, Dahm-Kähler P. Robotic and Open Surgery for Endometrial Cancer in Elderly Patients: Surgical Outcome, Survival, and Cost Analysis. Int J Gynecol Cancer. 2018; 28(4):692-99.
• 8. Gaia G, Holloway RW, Santoro L, Ahmad S, Di Silverio E, Spinillo A. Robotic-assisted hysterectomy for endometrial cancer compared with traditional laparoscopic and laparotomy approaches: a systematic review. Obstet Gynekol. 2010; 116(6):1422-31.
• 9. Chuan L, Yan S, Pei-Wu Y. Meta-analysis of short-term outcomes compared to robot-assisted laparoscopic gastrectomy. Minim Invader Ther Allied Technol. 2015; 24(3):127-34.
• 10. Roh HF, Nam SH, Kim JM. Robot-assisted laparoscopic surgery versus conventional laparoscopic surgery in randomized controlled trials: A systematic review and meta-analysis. PLoS ONE. 13(1):e0191628.
• 11. Mäenpää MM, Nieminen K, Tomás EI, et al. Robot-assisted conventional laparoscopic surgery for endometrial cancer: a randomized controlled trial. Am J Obstet Gynecol. 2016; 215:588.e1.
• 12. Beck TL, Schiff MA, Goff BA, Urban RR. Robotic, Laparoscopic or Open Hysterectomy: Surgical Outcomes by Approach in Endometrial Cancer. J Minim Invasive Gynecol. 2018; 25(6):986-93.
• 13. Lindfors A, Åkesson Å, Staf C, Sjöli P, Sundfeldt K, Dahm-Kähler P. Robotic and Open Surgery for Endometrial Cancer in Elderly Patients: Surgical Outcome, Survival, and Cost Analysis. Int J Gynecol Cancer. 2018; 28(4):692-99.
• 14. Agarwal R, Rajanbabu A, Unnikrishnan UG. Retrospective evaluation and cost comparison of perioperative drug use in robotic and open surgery for endometrial cancer. J Robot Surgeon. 2018; 12(4):665-72.
• 15. Benedet JL, Bender H, Jones H 3rd, et al. FIGO staging classifications and clinical practice guidelines in the management of gynecological cancers. FIGO Gynecological Oncology Committee. Int J Gynaecol Obstet. 2000; 70:209.
• 16. Edge SB, Compton CC. American Joint Committee on Cancer: 7th edition of the AJCC cancer staging guidelines and the future of TNM. Ann Surgeon Oncol. 2010; 17(6):1471-74.
• 17. Walker JL, Piedmonte MR, Spirtos NM, et al. Laparoscopy compared to laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol. 2009; 27:5331-36.
• 18. Papadia A, Remorgida V, Salom EM, Ragni N. Laparoscopic pelvic and paraaortic lymphadenectomy in gynecological oncology. J Am Associate Gynecol Laparosc 2004; 11:297.
• 19. Todo Y, Kato H, Kaneuchi M et al. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet. 2010; 375:1165.
• 20. Seamon LG, Cohn DE, Valmadre S et al. Robotic hysterectomy and lymphadenectomy for endometrial cancer: technical aspects and details of success-Ohio State University method. J Robot Surg. 2008; 2:71.
• 21. Shafer A, Boggess JF. Robot-assisted endometrial cancer staging and radical hysterectomy with the da Vinci surgical system. Gynecol Oncol. 2008; 111:S18.
• 22. Soliman PT, Langley G, Munsell MF, Vaniya HA, Frumovitz M, Ramirez PT. Analgesic and antiemetic requirements after minimally invasive surgery for early cervical cancer: a comparison between laparoscopy and robotic surgery. Ann Surg Oncol. 2013;20(4):1355-59