Robotic Dual-docking Surgery for Para-aortic Lymphadenectomy in Endometrial Cancer: a Prospective Feasibility Study

Overview

Journal Int J Clin Oncol

Specialty Oncology

Date 2024 Dec 21

PMID 39708238

Authors

Shintaro Yanazume

Hiroaki Kobayashi

Takashi Ushiwaka

Shinichi Togami

Masaki Kamio

Affiliations

Soon will be listed here.

Abstract

Background: The standard for robotic para-aortic lymphadenectomy has not been fully established. Para-aortic lymphadenectomy performed by sharing the same ports with pelvic procedures, a procedure known as dual-docking surgery, can be performed using the latest robotic system. We prospectively examined the ability of standardized dual-docking robotic surgery in endometrial cancer patients.

Methods: This study prospectively verified the feasibility and safety of dual-docking robotic surgeries performed between March 2017 and December 2021. The laterally placed ports were aligned with the umbilicus. Primary outcome was the surgical completion rate; secondary outcomes were blood loss, operative time, unexpected port placement, conversion, complications, length of hospital stay, and survival.

Results: Most patients (14/15, 93%) underwent surgery using our methods without additional port placements, and one patient was converted to laparotomy. Median blood loss was 162 mL (range: 20-685 mL). Median operative time was 183 and 206 min in the upper and lower abdomen. Median number of resected para-aortic lymph nodes was 19 (range: 6-29), and pelvic lymph nodes was 28 (range: 15-42). Although there was no difficulty in moving the forceps intraoperatively, major complications including vessel injury, and pelvic abscesses were observed. The lateral ports could be placed 6-10 cm apart in patients with any range of body type.

Conclusion: Dual-docking surgery for endometrial cancer has the potential to be a standard procedure for robotic endometrial cancer surgery, although a greater number of cases are needed to acquire proficiency.

Citing Articles

Robotic trachelectomy with sentinel lymph node biopsy for cervical cancer: a prospective study investigating minimally invasive radicality.

Kobayashi H, Yanazume S, Kamio M, Togami S, Ushiwaka T Int J Clin Oncol. 2025; .

PMID: 40038151 DOI: 10.1007/s10147-025-02718-0.

References

Franke O, Narducci F, Chereau-Ewald E, Orsoni M, Jauffret C, Leblanc E . Role of a double docking to improve lymph node dissection: when robotically assisted laparoscopy for para-aortic lymphadenectomy is associated to a pelvic procedure. Int J Gynecol Cancer. 2014; 25(2):331-6. DOI: 10.1097/IGC.0000000000000338. View

Cardenas-Goicoechea J, Adams S, Bhat S, Randall T . Surgical outcomes of robotic-assisted surgical staging for endometrial cancer are equivalent to traditional laparoscopic staging at a minimally invasive surgical center. Gynecol Oncol. 2010; 117(2):224-8. PMC: 2896309. DOI: 10.1016/j.ygyno.2010.01.009. View

Seamon L, Cohn D, Richardson D, Valmadre S, Carlson M, Phillips G . Robotic hysterectomy and pelvic-aortic lymphadenectomy for endometrial cancer. Obstet Gynecol. 2008; 112(6):1207-1213. DOI: 10.1097/AOG.0b013e31818e4416. View

Uccella S, Bonzini M, Palomba S, Fanfani F, Ceccaroni M, Seracchioli R . Impact of Obesity on Surgical Treatment for Endometrial Cancer: A Multicenter Study Comparing Laparoscopy vs Open Surgery, with Propensity-Matched Analysis. J Minim Invasive Gynecol. 2015; 23(1):53-61. DOI: 10.1016/j.jmig.2015.08.007. View

Coronado P, Fasero M, Magrina J, Herraiz M, Vidart J . Comparison of perioperative outcomes and cost between robotic-assisted and conventional laparoscopy for transperitoneal infrarenal para-aortic lymphadenectomy (TIPAL). J Minim Invasive Gynecol. 2014; 21(4):674-81. DOI: 10.1016/j.jmig.2014.01.023. View

Gehrig P, Cantrell L, Shafer A, Abaid L, Mendivil A, Boggess J . What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman?. Gynecol Oncol. 2008; 111(1):41-5. DOI: 10.1016/j.ygyno.2008.06.030. View

Loaec C, Bats A, Ngo C, Cornou C, Rossi L, Bensaid C . Dual docking robotic surgical staging for high risk endometrial cancer. Eur J Obstet Gynecol Reprod Biol. 2018; 225:79-83. DOI: 10.1016/j.ejogrb.2018.04.009. View

Ekdahl L, Salehi S, Falconer H . Improving Double Docking for Robot-assisted Para-aortic Lymphadenectomy in Endometrial Cancer Staging: Technique and Surgical Outcomes. J Minim Invasive Gynecol. 2016; 23(5):818-24. DOI: 10.1016/j.jmig.2016.03.023. View

Cunningham M, Dorzin E, Nguyen L, Anderson E, Bunn Jr W . Body mass index, conversion rate and complications among patients undergoing robotic surgery for endometrial carcinoma. J Robot Surg. 2015; 9(4):339-45. DOI: 10.1007/s11701-015-0538-8. View

10.

Boggess J, Gehrig P, Cantrell L, Shafer A, Ridgway M, Skinner E . A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J Obstet Gynecol. 2008; 199(4):360.e1-9. DOI: 10.1016/j.ajog.2008.08.012. View

11.

DeNardis S, Holloway R, Bigsby 4th G, Pikaart D, Ahmad S, Finkler N . Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lymphadenectomy for endometrial cancer. Gynecol Oncol. 2008; 111(3):412-7. DOI: 10.1016/j.ygyno.2008.08.025. View

12.

Pakish J, Soliman P, Frumovitz M, Westin S, Schmeler K, Dos Reis R . A comparison of extraperitoneal versus transperitoneal laparoscopic or robotic para-aortic lymphadenectomy for staging of endometrial carcinoma. Gynecol Oncol. 2013; 132(2):366-71. PMC: 4116735. DOI: 10.1016/j.ygyno.2013.12.019. View

13.

Magrina J, Long J, Kho R, Giles D, Montero R, Magtibay P . Robotic transperitoneal infrarenal aortic lymphadenectomy: technique and results. Int J Gynecol Cancer. 2010; 20(1):184-7. DOI: 10.1111/IGC.0b013e3181c208e4. View

14.

Hurd W, Bude R, DeLancey J, Pearl M . The relationship of the umbilicus to the aortic bifurcation: implications for laparoscopic technique. Obstet Gynecol. 1992; 80(1):48-51. View

15.

Seamon L, Cohn D, Henretta M, Kim K, Carlson M, Phillips G . Minimally invasive comprehensive surgical staging for endometrial cancer: Robotics or laparoscopy?. Gynecol Oncol. 2009; 113(1):36-41. DOI: 10.1016/j.ygyno.2008.12.005. View

16.

Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N . Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet. 2010; 375(9721):1165-72. DOI: 10.1016/S0140-6736(09)62002-X. View

17.

Yamagami W, Mikami M, Nagase S, Tabata T, Kobayashi Y, Kaneuchi M . Japan Society of Gynecologic Oncology 2018 guidelines for treatment of uterine body neoplasms. J Gynecol Oncol. 2019; 31(1):e18. PMC: 6918887. DOI: 10.3802/jgo.2020.31.e18. View

18.

Zanagnolo V, Rollo D, Tomaselli T, Rosenberg P, Bocciolone L, Landoni F . Robotic-assisted transperitoneal aortic lymphadenectomy as part of staging procedure for gynaecological malignancies: single institution experience. Obstet Gynecol Int. 2013; 2013:931318. PMC: 3747409. DOI: 10.1155/2013/931318. View

19.

Bebia V, Gil-Moreno A, Hernandez A, Gilabert-Estelles J, Franco-Camps S, De La Torre J . Robot-assisted Extraperitoneal Para-aortic Lymphadenectomy Is Associated with Fewer Surgical Complications: A Post Hoc Analysis of the STELLA-2 Randomized Trial. J Minim Invasive Gynecol. 2021; 28(12):2004-2012.e1. DOI: 10.1016/j.jmig.2021.05.009. View

20.

Jeong J, Kim Y, Kim J, Jee B, Kim S . Vertical distance between umbilicus to aortic bifurcation on coronal view in Korean women. Obstet Gynecol Sci. 2014; 57(1):44-9. PMC: 3924739. DOI: 10.5468/ogs.2014.57.1.44. View