Robot-assisted interventions in treatment of gynecological cancers: analysis of 5-year experience of the N.N. Blokhin National Medical Research Center of Oncology

Background. Robot-assisted surgery allows to overcome technical limitations of standard laparoscopy due to 3D visualization, elimination of physiological tremor, and use of instruments with seven movement degrees of freedom.

Aim. To evaluate perioperative and early oncological results of robot-assisted interventions in a mixed cohort of female patients with oncological diseases of the reproductive organs.

Materials and methods. A retrospective analysis of 310 patients who underwent surgery at the Division of Gynecology of the N.N. Blokhin National Medical Research Center of Oncology between June 2021 and December of 2025 with the use of the da Vinci surgical systems. The volume of surgical interventions, perioperative parameters, frequency of conversions, recurrence-free and overall survival were evaluated. The analysis was performed considering nosology of the disease: uterine cancer, cervical cancer, ovarian cancer.

Results. In patients with uterine cancer (n = 250), hysterectomy and extirpation of the fallopian tubes, in some cases in combination with resection of the ovaries, was performed. Access conversion was necessary in 1 case. Mean operative time was 120 (70–260) min, mean blood loss volume was 70 (10–1800) mL. Mean follow-up was 14.7 (1.0–55.4) months. Recurrence was detected in 2 (0.8 %) of 250 patients, both patients died due to disease progression. Recurrence-free and overall survival were 99.2 %. In patients with cervical cancer (n = 53), extirpation of the uterus, radical trachelectomy, pelvic lymph node dissection, radical and aborted hysterectomy were performed. Mean operative time was 210 (120–210) min, mean blood loss volume was 100 (50–400) mL. Conversion was necessary in 1 case. Mean follow-up was 13.6 (1.0–39.6) months. Recurrence was detected in 2 (3.8 %) patients. Recurrence-free survival was 96.2 %, overall survival was 98.1 %. In patients with ovarian tumors (n = 7), extirpation of the uterus with appendages or organ-saving treatment in the form of adnexectomy, as well as resection of the greater omentum were performed. Mean operative time was 90 (80–120) min, mean intraoperative blood loss volume was 90 (80–120) mL. No conversions, recurrences and deaths were reported during the mean follow-up of 8 (1.0–50.1) months.

Conclusion. The most reliable conclusion can be made for patients with uterine cancer: low frequency of conversions (0.4 %) and recurrences (0.8 %) confirms safety of the access including in 80 % of patients with obesity. For cervical cancer, the results align with the LACC and SUCCOR trial data, but robot-assisted interventions are allowed only after strict selection of patients of low risk. For early ovarian tumors, robot-assisted access is acceptable for staging, but it is not indicated for advanced disease. Data interpretation for these cases is limited, which dictates the necessity of further prospective studies.

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