| Objective:To compare the safety and efficacy of robotic-assisted laparoscopy and conventional laparoscopy for comprehensive staging of endometrial cancer,and to explore the short-term clinical efficacy,clinical advantages and learning curve of robotic-assisted laparoscopy for comprehensive staging of endometrial cancer,To provide a quantitative and objective basis for the selection of endometrial cancer surgical methods and to standardize the training of clinicians in robotic-assisted laparoscopic endometrial cancer comprehensive staging.Methods:The clinical data of 187 patients who underwent robotic-assisted laparoscopy and conventional laparoscopic comprehensive staging of endometrial cancer in the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Gannan Medical College from August 2019 to October 2021 were retrospectively collected.They were divided into robot-assisted laparoscopic surgery group(Robot-Assisted Laparoscopic Surgery group,97patients in RALS group)and conventional laparoscopic surgery group(Conventional Laparoscopic Surgery,90 patients in CLS group)according to different surgical methods.SPSS 25.0 software was used to select the correct statistical method to analyze and compare the basic data of patients[age,body mass index(BMI),pathological type,disease stage,preoperative comorbidities,history of pelvic surgery,etc.],and the operation was effective.Sexual indicators(operation time,postoperative hospital stay,total number of lymph nodes removed,etc.),surgical safety indicators[intraoperative complications,pelvic drainage tube placement time,intraoperative blood loss,postoperative complications(follow-up until 3months after surgery),pelvic drainage,etc.],economic indicators(hospitalization costs,surgical costs,etc.).The 55 patients with BMI≥24kg/m~2in RALS group were classified as the robotic overweight and obesity group(group A),and the 45 patients with BMI≥24kg/m~2in CLS group were classified as the laparoscopic overweight and obesity group(group B).SPSS25.0 software was used to analyze and compare the operation-related data(such as postoperative hospital stay,pelvic drainage,etc.)of the two surgical methods in overweight and obese patients.The learning curve was analyzed using the Cumulative Sum(CUSUM)method with the operation time as the main indicator.Results:1、There were no significant differences in basic data such as age,BMI,pathological type,disease stage,history of pelvic surgery,and preoperative comorbidities between the two groups.2、All patients who met the inclusion criteria underwent successful surgery,and there were no patients who were converted to laparotomy,who had no intraoperative complications,or who had no intraoperative blood transfusion.The operation time in the RALS group(276.61±56.14min)was longer than that in the CLS group(228.34±37.96min),and the difference was statistically significant(P=0.000<0.05).The postoperative hospital stay in the RALS group(7.18±1.68d)was shorter than that in the CLS group(7.67±1.58d),the difference was statistically significant(P=0.04<0.05);the total number of lymph nodes resected in the RALS group(69.44±17.59)was more than that in the CLS group(64.19±18.59),and the difference was statistically significant(P=0.049<0.05);the postoperative pelvic drainage volume in the RALS group(359.39±190.24ml)was less than that in the CLS group(589.12±286.70ml),and the difference was statistically significant(P=0.000<0.05);the operation cost and total hospitalization cost of the RALS group(29182.23±1863.77 yuan,46785.22±6909.36 yuan)were higher than the CLS group(10775.15±1165.23 yuan,33392.27±3577.75 yuan),the difference was statistically significant(P=0.000<0.05);but the intraoperative blood loss was 96.75±39.32ml in the RALS group,CLS group was100.57±34.96ml,the difference was not statistically significant(P=0.485>0.05);postoperative complication rates were 6.2%in RALS group and 12.2%in CLS group,with no significant difference(P=0.151>0.05);the indwelling time of pelvic drainage tube was 4.89±1.29d in the RALS group and 5.17±1.37d in the laparoscopic surgery group,with no significant difference(P=0.145>0.05).3、Comparing the efficacy of robotic-assisted laparoscopy and conventional laparoscopic comprehensive staging of endometrial cancer in overweight and obese patients,the results showed that compared with the CLS group,the intraoperative blood loss in the RALS group was less[(86.67±29.66ml vs.101.8±35.88ml).,P=0.023<0.05],the number of total lymph nodes removed was higher(70.80±17.52 vs.62.00±18.42,P=0.016<0.05),and the postoperative hospital stay was shorter[(6.89±1.71d vs.7.62±1.59d).,P=0.032<0.05],the difference was statistically significant.However,in terms of operation time,drainage tube indwelling time and postoperative complications,there was no significant difference between the RALS group and the CLS group(P>0.05).4、Ninety-seven patients who met the inclusion criteria were included in the learning curve analysis with the robot-assisted laparoscopic comprehensive staging of endometrial cancer.According to the CUSUM method,the operation time was used as the main index to analyze and draw the learning curve.The curve fitting R~2=0.82,P=0.000<0.05,the equation is Y=3.96E2+58.86*X-1.41*X~2+8.32E-3*X~3,the curve starts to turn from the 25th case.Conclusion:1、Robot-assisted laparoscopy and conventional laparoscopy are both safe and effective in the treatment of endometrial cancer.Compared with conventional laparoscopy,although the cost is higher,robot-assisted laparoscopy is safe and short-term clinical.It has better curative effect and is worthy of clinical promotion;2、Compared with conventional laparoscopic surgery,robot-assisted laparoscopic surgery has more obvious advantages in overweight and obese patients with endometrial cancer,with less intraoperative blood loss,more lymph node resection,shorter postoperative hospital stay and other advantages;3、On the basis of rich experience in laparoscopic surgery,the learning curve of robot-assisted laparoscopic comprehensive staging of endometrial cancer is 25 cases. |
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