Surgical technique
All surgical procedures were performed at a tertiary referral centre by
a surgical team consisting of two gynaecological oncologists (RV, RZ)
with similar experience in robot-assisted operation techniques. In all
patients with early stage cervical cancer and an indication for radical
surgery, the da Vinci (S until 2010 and Si until 2017) Surgical System
(Intuitive Surgical, Sunnyvale, USA) was used. Robot-assisted
laparoscopy was the standard of care, with laparotomy only performed in
10 cases during the inclusion period for those who had an absolute
contra-indication (e.g. advanced pregnancy, large uterus).Primary surgical treatment for early stage cervical cancer consisted
typically of robot-assisted pelvic sentinel lymph node (SLN) evaluation
and systematic lymph node dissection (PLND) combined with radical
hysterectomy or radical vaginal trachelectomy when fertility
preservation was desired and the maximum tumour diameter was ≤2 cm. When
sentinel nodes were found to be positive on frozen section, the intended
radical uterine surgery was discontinued and chemoradiation initiated.
In case of unexpected finding of cervical cancer after simple
hysterectomy (for benign indication), primary treatment was expanded
with robot-assisted PLND and parametrectomy. Details on the surgical
techniques performed at our institution have been previously
described.5,24