Feasibility of Robotic-Assisted Laparoendoscopic Single-Site Surgery in the Gynecologic Oncology Setting

Study Objective: To assess the feasibility of incorporating robotic laparoendoscopic single-site (R-LESS) surgery into gynecologic oncology care. Design: Retrospective study (Canadian Task Force classification II-3). Setting: Academic university hospital. Patients: Patients undergoing R-LESS hysterectomy for gynecologic malignancies, preinvasive disease, or risk reduction performed by a single gynecologic oncologist between 2014 and 2016. Interventions: We incorporated R-LESS as part of standard surgical management for highly selected patients undergoing hysterectomy for common gynecologic oncology indications. Measurements and Main Results: We identified 30 patients undergoing R-LESS hysterectomy meeting study criteria over a 2-year period. Indications for surgery included uterine cancer (n = 13), preinvasive cervical or uterine disease (n = 9), cervical cancer (n = 3), and hereditary gynecologic cancer risk (n = 5). Median patient age was 52 years (range, 35-77), and body mass index was 26 kg/m² (range, 19-34). Median uterine size was 8 cm (range, 5.5-11). Eighteen patients had prior abdominal surgery (60%). Twenty-seven patients underwent R-LESS extrafascial hysterectomy, 11 of whom underwent only robotic-assisted total laparoscopic hysterectomy ± bilateral salpingo-oophorectomy with a median operative time of 140 minutes (range, 115-179). Procedures performed concurrently for the remainder included pelvic sentinel lymph node mapping (n = 14) and pelvic lymphadenectomy (n = 2), with respective median operative times of 175 (range, 150-230) and 233 minutes. One patient with endometrial cancer was converted to multiport robotic surgery to complete a pelvic and para-aortic lymphadenectomy due to high-risk disease on frozen section. Three patients underwent R-LESS radical hysterectomy, bilateral salpingo-oophorectomy, sentinel lymph node mapping, and pelvic lymphadenectomy with a median operative time of 412 minutes (range, 336-451). No perioperative complications were encountered, and all patients were discharged within 24 hours of surgery. Conclusion: In highly selected patients, R-LESS extrafascial and radical hysterectomy is associated with acceptable operative times and perioperative outcomes. With additional experience, surgeons may offer this approach to patients undergoing increasingly complex procedures, even in the gynecologic oncology setting.