Design
We performed an observational cohort study reporting on all patients treated consecutively with robot-assisted laparoscopy for early stage cervical cancer (FIGO stage IA1, IA2, IB1 and IIA1 according to 2009 FIGO staging and guidelines23) between 1 December 2007 and 1 April 2017. Inclusion criteria were a histopathologically proven carcinoma of the cervix and the intention to perform robot-assisted radical surgery as primary treatment. Patients were excluded in case of an ongoing pregnancy or when treated with neoadjuvant chemotherapy. All procedures were part of standard clinical care, for which informed consent was obtained.
The primary outcome of interest was surgical proficiency, based on cervical recurrence rate. Secondary outcomes were disease-free survival (DFS), disease-specific survival (DSS) and overall survival (OS) in the different learning phases. Survival was defined as the time interval between date of diagnosis or first visit and date of disease recurrence diagnosis (DFS) or death due to the sequelae of cervical cancer (DSS) or death from any cause (OS).