Robotic-assisted single-port and multi-port surgical staging in early-stage endometrial cancer: a propensity matched comparison

Abstract

INTRODUCTION: Robotic-assisted surgery has emerged as an effective method for managing endometrial cancer. Recently, the new Da Vinci Single-Port (SP) was developed with the aim of minimizing surgery-related morbidity, using a single-port approach. The present research evaluated outcomes of apparent early-stage endometrial cancer patients undergoing single- and multi-port robotic-assisted surgery. MATERIAL AND METHODS: This is a retrospective study. Data of consecutive patients affected by early-stage endometrial cancer who had robotic-assisted staging (including hysterectomy, bilateral salpingo-oophorectomy and nodal staging) with Da Vinci SP were matched 1:1 with a cohort of patients undergoing robotic-assisted surgery with the multi-port Da Vinci Xi. The matching was conducted by a propensity-score comparison. RESULTS: Fifty patient pairs (50 undergoing single-port surgical staging vs. 50 undergoing multiple-port surgical staging) were included. Demographic and baseline characteristics were balanced between groups. Median (skin to skin) operative time (minutes) was similar between groups (120 (range, 70-229) in the single-port vs. 115 (range, 60-205) in the multi-port group; p = 0.367). Estimated blood loss was comparable between groups (p = 0.317). No intra-operative complications or intra-operative blood transfusions were recorded. The median length of hospital stay was similar between groups (p = 0.269). Overall, 10 (10 %) patients developed 90-day surgery-related complications: six (12 %) and four (8 %) in the single- and multi-port group, respectively (p = 0.740). One (2 %) and two (4 %) patients experienced severe (grade 3 or more) 90-day complications after single- and multi-port robotic-assisted staging (p = 1.00). CONCLUSIONS: Introducing Da Vinci SP appears to be safe and feasible. The single-port approach does not increase operative time and complication rates in comparison to the multi-port robotic-assisted system.