| Objective:At present, a large number of literature elaborated that laparoscopic radical hysterectomy and open surgery have the same clinical effects; and the use of the laparoscopic radical hysterectomy is promoted in clinical. With the development of society, people gradually found that traditional laparoscopy has many disadvantages, so the robotic surgery system is developed. The robotic surgery system is a new surgical platform; when conceived, scholars' main idea is that using minimally invasive to complete some complex surgical procedures. Compared with conventional laparoscopic surgery, the robotic surgery system is a totally different surgery concept; the robotic surgery system is the first surgical surgical mode in the global field of minimally invasive, which is an epochal achievement. In 2003, computer Motion company was purchased by Intuitive Surgical, and computer Motion developed the da Vinci robotic surgery system based on Zeus system. This system is the only one that was produced in the world and was gradually developed in clinical. This system can provide a three-dimensional image with high-resolution, which has a zoom function for making the surgical field become more clear; and the system has seven degrees of freedom, which can simulate the movement of a human hand; thus, surgeons can have a better cutting, fine stitching and reconstruction. These advantages of the da Vinci robotic surgery system can ease the hand fatigue of surgeons, provide clearer images and increase the flexibility of the surgery, such that the safety of the surgery is greatly increased. Its appearance likely to cause a significant change for the concept of minimally invasive surgery. Due to its special design, da Vinci robotic surgery system reduces the difficulty of each operation in the surgery, which can promote the popularity of minimally invasive surgery; meanwhile, da Vinci robotic surgery can improve the accuracy of the operation, which will make remote operation possible. At the early 2000 s, the US Food and Drug Administration allowed da Vinci robotic surgery system to be applied in gynecologic field, and then da Vinci robot-assisted radical hysterectomy was gradually applied on cervical cancer patients. The emergence of a new surgical approach needs to be continuously tested through clinical practice, to verify its clinical effectiveness and application value. When radical hysterectomy is completed under robot assistance and radical hysterectomy is gradually applied in clinical, a problem appears, that is, compared with traditional open surgery and laparoscopic surgery, what advantages does robotic surgery have and how is the safety and feasibility, these are needed to be further tested through clinical trials. A decade ago, such surgery has been carried out in foreign country; in domestic, the first robotic gynecological surgery was completed by the People's Liberation Army General Hospital in 2008. In 2013, our hospital carried out such surgery and conducted the related research; it is aimed to compare the short-term effects of da Vinci robot-assisted radical hysterectomy and Laparoscopic radical hysterectomy for treating early cervical cancer, to discuss the safety and advantages of da Vinci robot-assisted radical hysterectomy for treating early cervical cancer, and to provide objective evidence to prove the safety and advantages of da Vinci robot-assisted radical hysterectomy for treating early cervical cancer.Methods: In this research, pathological data of patients who were diagnosed with FIGO stage IA2~IIA cervical cancer from October 2014-December 2015 at obstetrics and gynecology department of Xijing Hosipital are included, for a retrospective study; 137 patients are included in the research, which are all in line with the diagnostic criteria of cervical cancer with no surgical contraindications; 86 cases underwent da Vinci robot-assisted radical hysterectomy(robotic group), and 51 cases underwent conventional laparoscopic radical hysterectomy(laparoscopic group). Surgical approach is decided according to the wishes of patients and their families and the specific conditions. The clinical outcomes were compared among different groups: age, body mass index, blood loss, the operative time, the number of pelvic lymph nodes removed,pathology,the length ofhospital stay, post-operative conditions,follow-up.Results: 1. No statistical difference, concerning the age, body mass index, pathological type, were found among groups. Patients of the two groups underwent the operation successfully without any convertion to laparotomy. 2. Intra-operative conditions: the operative time of the robotic group is 201.16±30.66 minutes, and the operative time of the laparoscopic group is 174.07±30.28 minutes, the comparative difference between the robotic group and the laparoscopic group is statistically significant(t=5.020, P<0.001); the intra-operative blood loss of the robotic group is 62.09±36.88 ml, and the intra-operative blood loss of the laparoscopic group is 105.29±65.34ml; the comparative difference between the robotic group and the laparoscopic group is statistically significant(t=-4.330, P<0.001). 3. Post-operative pathological conditions: the number of pelvic lymph nodes removed is 22.66±5.71 for the robotic group; the number of pelvic lymph nodes removed is 19.64±6.35 for the laparoscopic group; the comparative difference of the two groups is statistically significant(t=2.865, P =0.005). 4. Post-operative conditions: the time of anal exsufflation is 31.61±9.31 hours for the robotic group, the time of anal exsufflation is 41.21±9.69 hours for the laparoscopic group, and the comparative difference between the robotic group and the laparoscopic group is statistically significant(t=-5.743,P<0.001); the time of indwelling catheter is 20.89±12.58 hours for the robotic group, the time of indwelling catheter is 26.27±12.74 hours for the laparoscopic group, and the comparative difference between the robotic group and the laparoscopic group is statistically significant(t=-2.407,P=0.017); the hospital stay is 5.73±1.42 days for the robotic group, the hospital stay is 6.74±1.93 days for the laparoscopic group; the comparative difference between the robotic group and the laparoscopic group is statistically significant(t=-3.506,P=0.001). 5. No recurrence or death happened in the postoperative follow-up for all the patients.Conclusions:1.When compared the blood loss, the blood loss of the robotic group is less than the laparoscopic group.2. When compared the anal exsufflation time and the hospital stay time, the time of the robotic group is shorter than the laparoscopic group.3. When compared the indwelling catheter time, the time of the robotic group is shorter than the laparoscopic group.4. No recurrence or death happened in the postoperative follow-up for the two groups.5. Compared with the conventional laparoscopic radical hysterectomy, Da Vinci robotic surgery system has superiority.6. For the treatment of early stage cervical cancerit, Da Vinci robot-assisted radical hysterectomy is a safe and feasible operation. |
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