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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2020.tde-09032020-101308
Document
Author
Full name
Alexandre Silva e Silva
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Carvalho, Jesus Paula (President)
Genta, Maria Luiza Nogueira Dias
Haddad, Jorge Milhem
Nicolau, Sérgio Mancini
Title in Portuguese
Estudo prospectivo randomizado para avaliação dos desfechos peri-operatórios e custos em cirurgias laparoscópicas e robóticas para o estadiamento completo do carcinoma de endométrio
Keywords in Portuguese
Complicações pós-operatórias
Medição de risco
Neoplasias do endométrio
Previsões
Sobrevida
Telecirurgia
Abstract in Portuguese
INTRODUÇAO: Estudos prospectivos, randomizados controlados, comparando a cirurgia laparoscópica assistida por robô e laparoscopia tradicional na cirurgia estadiadora do carcinoma do endométrio, são escassos e incompletos, pois não contemplaram a linfadenectomia retroperitoneal. OBJETIVO: O objetivo deste estudo foi avaliar os desfechos perioperatórios e os custos após a implementação da cirurgia robótica, comparadas com a cirurgia laparoscópica convencional, no estadiamento completo do carcinoma do endométrio. MÉTODOS: Oitenta e nove pacientes com carcinoma de endométrio, foram randomizadas de 2015 a 2017 e submetidas a cirurgia robótica (44 casos) vs. cirurgia laparoscópica (45 casos). Comparamos os dados demográficos, o número de linfonodos recuperados, tempo total de cirurgia, tempo de cada etapa cirúrgica, perda de sangue, tempo de internação, complicações e custos. RESULTADOS: Nos grupos de cirurgia robótica e laparoscópica a idade variou de 47 a 69 anos, vs. 48 a 69 anos, com mediana de 60 anos nos dois grupos. O IMC variou de 21,4 a 54,2 com mediana de 31,1 no grupo da robótica, vs. 22,9 a 58,6 com mediana de 31,6 no grupo da cirurgia laparoscópica. Da mesma forma, o tamanho do tumor variou de 4,0 (1,5-10,0) vs. 4,0 (0,0 a 9,0) cm], o número de linfonodos recuperados variou de 19 (3-61) e 20 (4-34)] e o número de complicações severas foi de 8 em cada grupo. CONCLUSÃO: A cirurgia robótica com o robô da Vinci® Si (Intuitive Surgery Inc., CA, EUA) para a cirurgia estadiadora do câncer de endométrio, nesta série de casos, não foi superior à cirurgia laparoscópica em relação aos desfechos clínicos e complicações. Observou-se custos mais elevados e maior duração do procedimento de cirurgia robótica em relação à cirurgia laparoscópica. Novos estudos prospectivos randomizados com modelos mais atuais de robô são necessários para o fortalecimento das evidências
Title in English
Prospective randomized study to evaluate perioperative outcomes and costs of laparoscopic and robotic surgey to complete endometrial cancer staging
Keywords in English
Endometrial neoplasms
Forecasting
Postoperative complications
Risk assessment
Survival
Telesurgery
Abstract in English
BACKGROUND: Randomized controlled studies comparing robotic-assisted laparoscopic surgery to traditional laparoscopic in gynecology oncology didn´t contemplate a complete surgical staging with retroperitoneal lymphadenectomy for a complete endometrial cancer staging. OBJECTIVE: The purpose of this study was to evaluate the clinical outcome and costs after the implementation of robotic surgery in the treatment of endometrial cancer, compared to conventional laparoscopic approach. METHODS: Eighty-nine patients with endometrial carcinoma, clinically restricted to the uterus, were randomized to this prospective study, from 2015 to 2017, for robotic surgery (44 cases) and laparoscopic surgery (45 cases). We compared the number of retrieved lymph nodes, total time of surgery, time of each surgical step, blood loss, length of hospital stay, major and minor complications, conversion rates and costs. RESULTS: Robotic and laparoscopic surgery groups had ages from 47 to 69 vs. 48 to 69, resulting in comparable median ages of 60 years old. The BMI variation was from 21,4 to 54,2 with median of 31,1 for the robotic group, and a variation from 22,9 to 58,6, with a median of 31,6 for the laparoscopic group. Likewise, the median tumor size was [4.0 (1.5 -10.0) vs. 4.0 (0.0 - 9.0) cm], median total number of lymph nodes retrieved [19 (3-61) and 20 (4-34)] and the number of major complications [8 vs. 8] were similar in both groups. In contrast, the median total duration of the whole procedure was longer [319.5 (170-520) vs. 248 (85-465) minutes] and the total cost [9,655 U$ dollar (SD ± 850) vs. 6,812 U$ dollar (SD ± 1849), p < 0,001] was higher in robotic compared to laparoscopic surgery. CONCLUSION: Robotic surgery using da Vinci® Si robot (Intuitive Surgery Inc., CA, USA) for endometrial cancer staging, is not superior to laparoscopic surgery regarding clinical outcomes and complications. The additional observation of higher costs and longer procedure duration of robotic surgery using this robot model, keep at the moment, the traditional laparoscopy as a gold standard option to endometrial cancer staging surgery in our institution. Prospective randomized studies using the newest robotic technology is needed to improve data
 
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Publishing Date
2020-03-09
 
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