Reproducibility and accuracy of robot-assisted laparoscopic fertility sparing radical trachelectomy

Objective. To assess the accuracy and reproducibility of robot-assisted laparoscopic abdominal fertility sparing radical trachelectomy in women with early stage cervical cancer. Methods. Relevant prospective clinical data from 13 consecutive women planned for robotic radical trachelectomy between 2007 and 2012 were compared with retrospective data from 12 consecutive women planned for vaginal radical trachelectomy between 2000 and 2007. The first follow up on all women included a similar vaginal ultrasonographic measurement of the remaining cervical length and the position of the cerclage, enabling a direct comparison. Peri- and postoperative clinical data were evaluated. Results. The remaining cervical length was equal between the robotic and vaginal procedures (mean 11 mm, range 8-13 mm; mean 11 mm, range 5-19 mm respectively, p = 0.92). The distance from the cerclage to the inner cervical os was significantly shorter and less variable in the robot group (robot mean 2 mm, range of 1-4 mm, vaginal mean 4 mm, range 2-7 mm, p = 0.003). Rejection of the cerclage (n = 3) and/or cervical stenosis (n = 3) was diagnosed in four women, all of whom in the vaginal group, between one and 13 months after surgery. Conclusions. Robotic trachelectomy is equally reproducible and accurate as the vaginal trachelectomy in terms of the remaining cervical length and results in a significantly more precise placement of the cerclage. (C) 2012 Elsevier Inc. All rights reserved.