BACKGROUND: This study was a secondary analysis of the ROBOGYN-1004 trial conducted between 2010 and 2015. The study aimed to identify factors that affect postoperative morbidity after either robot-assisted laparoscopy (RL) or conventional laparoscopy (CL) in gynecologic oncology.
METHODS: The study used two-level logistic regression analyses to evaluate the prognostic and predictive value of patient, surgery, and center characteristics in predicting severe postoperative morbidity 6 months after surgery.
RESULTS: This analysis included 368 patients. Severe morbidity occurred in 49 (28 %) of 176 patients who underwent RL versus 41 (21 %) of 192 patients who underwent CL (p = 0.15). In the multivariate analysis, after adjustment for the treatment group (RL vs CL), the risk of severe morbidity increased significantly for patients who had poorer performance status, with an odds ratio (OR) of 1.62 for the 1-point difference in the WHO performance score (95 % CI 1.06-2.47; p = 0.027) and according to the type of surgery (p < 0.001). A focus on complex surgical acts showed significant more morbidity in the RL group than in the CL group at the less experienced centers (OR, 3.31; 95 % CI 1.0-11; p = 0.05) compared with no impact at the experienced centers (OR, 0.87; 95 % CI 0.38-1.99; p = 0.75).
CONCLUSIONS: The findings suggest that the center\'s experience may have an impact on the risk of morbidity for patients undergoing complex robot-assisted surgical procedures.

(1) Background: This study aimed to analyze the impact of surgical approach on survival rates in women diagnosed with endometrial cancer. (2) Methods: A retrospective multicenter cohort of 1382 women diagnosed with EC was performed. A total of 684 (49.5%) women underwent minimally invasive surgery, 233 (34%) underwent robotic-assisted laparoscopy (RAL), 451 (66%) underwent conventional laparoscopy (LPS), and 698 (50.5%) underwent open surgery (OP). Sociodemographic features, tumor characteristics, and survival rates were analyzed in the whole sample and in a matched-pair model. (3) Results: Women operated on by OP were significantly older, presented more comorbidities, and had more aggressive tumors. Disease-free (DFS), overall (OS), and specific survival related to EC (SS) amounts were significantly higher for MIS compared to OP (p < 0.001). When matched by age, body mass index, comorbidities, ASA score, histological type, grade, myometrial invasion, and FIGO stage, 798 patients were selected. DFS, OS, and SS amounts were similar between the MIS and OP groups. (4) Conclusions: The surgical approach for women with EC does not impact DFS or OS amounts when matched by homogeneous groups.

Minimally invasive hysterectomy is the standard of care in the majority of women diagnosed with endometrial cancer via robotic-assisted, multiport, and single-port laparoscopy technology. Although safe and efficacious, it is unclear how oncologic outcomes are impacted by surgical platform.
To identify differences in progression-free survival and overall survival in women undergoing minimally invasive surgery for endometrial cancer staging via either multiport, single-port, or robotic-assisted laparoscopy.
A multicenter, single-institution retrospective cohort study was performed in women with a diagnosis of endometrial cancer who underwent minimally invasive surgery from 2009 to 2015. Data were collected for demographics, pathologic information, adjuvant treatment, and disease status. Pearson χ2 and Fisher exact tests were used to evaluate risk factors for outcomes, Kaplan-Meier estimates and Cox proportional hazards were used to evaluate differences in time to progression or death, and multivariate regression analysis was performed.
In total, 1150 women with endometrial cancer underwent robotic-assisted laparoscopy (n=652), multiport laparoscopy (n=214), or single-port laparoscopy (n=284). The median age and body mass index of women was 62.0 years and 33.5 kg/m2, respectively. The majority of patients had endometrioid histology (88.1%), stage IA (74.7%) or IB disease (13.1%) and International Federation of Gynecology and Obstetrics grade 1 (57.4%) or 2 (26.0%) histology. Lymphovascular space invasion was present in 24.7% (n=283). Adjuvant radiation was given in 34.2% of cases, with 21.9% receiving vaginal brachytherapy, 6.6% pelvic radiation, and 5.4% both. For the entire cohort, there were no differences in progression-free survival at 2, 3, and 5 years for multiport laparoscopy (94.2%, 91.4%, 87.4%), robotic-assisted laparoscopy (94.5%, 92.9%, 88.8%), and single-port laparoscopy (93.6%, 91.2%, 90.0%) (P=.93), respectively. Similarly, there were no differences in overall survival at 2, 3, and 5 years for multiport laparoscopy (94.4%, 91.8%, 91.8%), robotic-assisted laparoscopy (95.6%, 93.4%, 90.7%), and single-port laparoscopy (95.0, 93.1, 91.8) (P=.99), respectively. Among women with stage IA and IB disease, no difference existed for progression-free survival at 2, 3, and 5 years for multiport laparoscopy (94.2%, 91.4%, 87.4%), robotic-assisted laparoscopy (94.5%, 92.9%, 88.8%), and single-port laparoscopy (93.6, 91.2, 90.0) (P=.93), respectively. Similarly, among women with stage I disease, there was no difference in overall survival at 2, 3, and 5 years for multiport laparoscopy (96.2%, 95.0%, 95.0%), robotic-assisted laparoscopy (96.6%, 95.4%, 93.3%), and single-port laparoscopy (96.6%, 95.0%, 93.4%) (P=.89). Rather, progression-free survival and overall survival were predicted by age >65 years, stage, grade, and histology (P<.05). On multivariate analysis, modality of surgery did not impact overall survival or progression-free survival (robotic-assisted laparoscopy, hazard ratio, 1.28, P=.50; single-port laparoscopy, hazard ratio, 0.84, P=.68 vs multiport laparoscopy). Age >65 years (hazard ratio, 5.42, P<.001) and advanced stage disease (P=.003) were associated with decreased overall survival.
In this retrospective cohort, there was no difference in progression-free survival or overall survival in women undergoing surgery for endometrial cancer via robotic-assisted laparoscopy, single-port laparoscopy, or multiport laparoscopy.

Surgeons work in awkward work postures and have high precision demands - well-known risk factors for musculoskeletal pain. Robotic-assisted laparoscopy is expected to be less demanding compared to conventional laparoscopy; however, studies indicate that robotic-assisted laparoscopy is also associated with poor ergonomics and musculoskeletal pain. The ergonomic condition in the robotic console is partially dependent upon the chair provided, which often is a regular office chair. Our study quantified and compared the muscular load during robotic-assisted laparoscopy using one of two custom built ergonomic chairs and a regular office chair. The results demonstrated no differences that could be considered clinically relevant. Overall, the study showed high levels of static and mean muscular activity, increased perceived physical exertion from pre-to-post surgery, and moderate to high risk for musculoskeletal injuries measured by the Rapid Upper Limb Assessment worksheet. Authors advocate for further investigation in surgeons\' ergonomics and physical work demands in robotic surgery.

BACKGROUND: We compared renal functional outcomes of robotic (RPN) and open partial nephrectomy (OPN) in patients with chronic kidney disease (CKD), a definite indication for nephron-sparing surgery.
METHODS: A multicenter retrospective analysis of OPN and RPN in patients with baseline ≥ CKD Stage III [estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2] was performed. Primary outcome was change in eGFR (ΔeGFR, mL/min/1.73 m2) between preoperative and last follow-up with respect to RENAL nephrometry score group [simple (4-6), intermediate (7-9), complex (10-12)]. Secondary outcomes included eGFR decline > 50%.
RESULTS: 728 patients (426 OPN, 302 RPN, mean follow-up 33.3 months) were analyzed. Similar RENAL score distribution (p = 0.148) was noted between groups. RPN had lower median estimated blood loss (p < 0.001), and hospital stay (3 vs. 5 days, p < 0.001). Median ischemia time (OPN 23.7 vs. RPN 21.5 min, p = 0.089), positive margin (p = 0.256), transfusion (p = 0.166), and 30-day complications (p = 0.208) were similar. For OPN vs. RPN, mean ΔeGFR demonstrated no significant difference for simple (0.5 vs. 0.3, p = 0.328), intermediate (2.1 vs. 2.1, p = 0.384), and complex (4.9 vs. 6.1, p = 0.108). Cox regression analysis demonstrated that decreasing preoperative eGFR (OR 1.10, p = 0.001) and complex RENAL score (OR 5.61, p = 0.03) were independent predictors for eGFR decline > 50%. Kaplan-Meier analysis demonstrated 5-year freedom from eGFR decline > 50% of 88.6% for OPN and 88.3% for RPN (p = 0.724).
CONCLUSIONS: RPN and OPN demonstrated similar renal functional outcomes when stratified by tumor complexity group. Increasing tumor age and tumor complexity were primary drivers associated with functional decline. RPN provides similar renal functional outcomes to OPN in appropriately selected patients.