# Implementation of Robotic-Assisted Surgery for the Treatment of Patients with Endometrial Carcinoma

## TL;DR

Robotic-assisted surgery for endometrial cancer reduced laparotomy rates, hospital stays, and improved lymph node mapping success compared to traditional methods.

## Contribution

Demonstrates significant clinical benefits of adopting robotic-assisted surgery in endometrial carcinoma treatment.

## Key findings

- Robotic surgery reduced laparotomy rates from 36.4% to 11.9% and eliminated laparotomy in FIGO Stage I disease.
- Hospital stays decreased by 25% and sentinel lymph node mapping success increased from 54.5% to 91%.
- Complication rates remained comparable, confirming safety during the learning curve.

## Abstract

This retrospective cohort study evaluated the impact of robotic-assisted surgery implementation on endometrial carcinoma outcomes at a tertiary care center. Among 122 patients treated across two periods (March 2022–February 2025), the introduction of robotic surgery in September 2023 significantly transformed surgical practice. Key findings demonstrated a 67% reduction in laparotomy rates (36.4% to 11.9%, p < 0.001), complete elimination of laparotomy in FIGO Stage I disease, and a 25% reduction in hospital stay (4 to 3 days, p < 0.001). Sentinel lymph node mapping success improved dramatically from 54.5% to 91.0% (p < 0.001), while completion staging procedures were eliminated entirely (9.1% to 0%, p = 0.017). Complication rates remained comparable between groups, confirming safety during the learning curve. These findings support robotic surgery adoption for enhancing minimally invasive capabilities and optimizing perioperative outcomes in endometrial carcinoma management.

Objective: This retrospective cohort study compares surgical outcomes among patients with endometrial carcinoma (EC) after the implementation of a robotic-assisted (RA) surgical program at a tertiary care center. Methods: A total of 122 EC patients who underwent surgery between March 2022 and February 2025 were included. Patients were divided into two cohorts based on the implementation of RA surgery: Group 1 (March 2022–August 2023) and Group 2 (September 2023–February 2025). Data collected included demographics, surgical approach, operative time, hospital stay, completion of staging procedures, and 30-day postoperative complications. Results: RA laparoscopy was used predominantly in Group 2, replacing conventional laparoscopy (CL). Laparotomy was significantly less frequent in group 2 (11.9% vs. 36.4%; p < 0.001). Among patients with FIGO stage I, all patients underwent minimally invasive surgery (MIS) in Cohort 2 (100% vs. 71.9%; p < 0.001). Median hospital stay was significantly shorter in Group 2 (3 days vs. 4 days; p < 0.001). A 30-day mortality occurred in one patient (n = 1) within the total study cohort (0.82%) and was attributed to pulmonary embolism on postoperative day 14 after RA laparoscopy. Rates of Grade ≥3 postoperative complications were similar (7.3% vs. 7.5%), as were wound complications (5.5% vs. 3%). The use of sentinel lymph node (SLN) mapping increased significantly in Group 2 (91% vs. 54.5%; p < 0.001). Completion staging procedures were significantly reduced in group 2 (9.1% vs. 0%; p = 0.017). Conclusions: The integration of RA laparoscopy significantly reduced laparotomy rates and hospital stays while increasing SLN mapping. These results support the continued adoption of RA laparoscopy to enhance MIS and improve patient outcomes.