Learning curve for robot-assisted and laparoscopic retroperitoneal lymphadenectomy in endometrial cancer

Aim. To objectify the significance of practical experience in retroperitoneal lumbar lymphadenectomy, an attempt was made to analyze, which consisted in studying the learning curve, which included the dynamics of specific indicators that change as experience accumulates.

Materials and methods. A cohort retrospective study was conducted, including 91 patients with verified uterine body cancer of stages I–III, who were treated in the oncogynecology department № 70 of the S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center from 2023 to 2025.

Results. The plateau of the time of laparoscopic operations was reached from the 47th operation (before 265 ± 40 min, after 170 ± 23 min). However, the number of removed lymph nodes reached a consistently high value by the 20th operation (before 20 ± 5, after 28 ± 4). In the group of robot-assisted retroperitoneal lumbar lymphadenectomy from the beginning of the mastering of the technique, the operation time was reduced by 1.5 times to the 18th operation (the median time of operations from the beginning of the development of the technique to the 18th operation is 272 ± 43 min, after 180 ± 27 min). The tendency to reduce the time of surgical intervention became more obvious after the rejection of the 4th robotic “arm” due to greater convenience in the surgical field. Similarly, the plateau of the number of removed lymph nodes was reached after the 18th operation (before 19 ± 5, after 26 ± 3).

Conclusion. The complexity of pelvic and paraaortic lymphadenectomy leads to the search for optimal surgical technologies, which in turn can be objectively assessed only after overcoming the learning curve.

1. Siegel R.L., Giaquinto A.N., Jemal A. Cancer statistics, 2024. CA Cancer J Clin 2024;74(1):12–49. DOI: 10.3322/caac.21820

2. Malignant Neoplasms in Russia in 2023 (Incidence and Mortality). Ed. by A.D. Kaprin, V.V. Starinsky, O.A. Shakhzadova. Moscow: P. Hertsen Moscow Oncology Research Center – branch of the National Medical Research Radiological Center, 2024. (In Russ).

3. Concin N., Matias­Guiu X., Cibula D. et al. ESGO–ESTRO–ESP guidelines for the management of patients with endometrial carcinoma: update 2025. Lancet Oncol 2025;26(8):e423–35. DOI: 10.1016/S1470­2045(25)00167­6

4. Todo Y., Kato H., Kaneuchi M. et al. Survival effect of para­aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 2010;375(9721):1165–72. DOI: 10.1016/S0140­6736(09)62002­X

5. Petousis S., Christidis P., Margioula­Siarkou C. et al. Combined pelvic and para­aortic is superior to only pelvic lymphadenectomy in intermediate and high­risk endometrial cancer: a systematic review and meta­analysis. Arch Gynecol Obstet 2020;302(1):249–63. DOI: 10.1007/s00404­020­05587­2

6. Lee H.J., Lee Y.H., Chong G.O. et al. Comparison of roboticassisted versus laparoscopy for transperitoneal infrarenal para­aortic lymphadenectomy in patients with endometrial cancer. J Obstet Gynaecol Res 2018;44(3):547–55. DOI: 10.3892/ol.2023.13761

7. Dowdy S.C., Aletti G., Cliby W.A. et al. Extra­peritoneal laparoscopic para­aortic lymphadenectomy – a prospective cohort study of 293 patients with endometrial cancer. Gynecol Oncol 2008;111(3):418–24. DOI: 10.1016/j.ygyno.2008.08.021

8. Ramirez P.T., Jhingran A., Macapinlac H.A. et al. Laparoscopic extraperitoneal para­aortic lymphadenectomy in locally advanced cervical cancer: a prospective correlation of surgical findings with positron emission tomography/computed tomography findings. Cancer 2011;117(9):1928–34. DOI: 10.1002/cncr.25739

9. Vasilev S.A., McGonigle K.F. Extraperitoneal laparoscopic para­aortic lymph node dissection. Gynecol Oncol 1996;61(3):315–20. DOI: 10.1006/gyno.1996.0149

10. Ebbinghaus H. Memory: A Contribution to Experimental Psychology. New York: University Microfilms, 1913. P. 169. DOI: 10.5214/ans.0972.7531.200408

11. Alimov V.A., Novikova E.G., Grekov D.N. et al. Comparative analysis of surgical approaches for para­aortic lymphadenectomy in endometrial cancer patients. Sibirsky onkologichesky zhurnal = Siberian Journal of Oncology 2025;24(3):15–26. (In Russ.) DOI: 10.21294/1814­4861­2025­24­3­15­26

12. Querleu D., Morrow C.P. Classification of radical hysterectomy. Lancet Oncol 2008;9(3):297–303. DOI: 10.1016/S1470­2045(08)70074­3

13. Alimov V.A., Lebedev S.S., Grekov D.N. et al., inventors. Method of robot­assisted retroperitoneal lumbar lymphadenectomy. RU patent 2,850,991. November 17, 2025.

14. Yoshida H., Yamamoto M., Shigeta H. Learning curve of laparoscopic extraperitoneal para­aortic lymphadenectomy for endometrial carcinoma: a cumulative sum analysis. Surg Oncol 2020;35:254–60. DOI: 10.1016/j.suronc.2020.09.008

15. Schermerhorn S.M.V., Christman M.S., Rocco N.R. et al. Learning curve for robotic­assisted laparoscopic retroperitoneal lymph node dissection. J Endourol 2021;35(10):1483–9. DOI: 10.1089/end.2020.0549

16. Angerer M., Wülfing C., Dieckmann K.­P. Robotic retroperitoneal lymph node dissection for testicular cancer–first experience and learning curve of a single surgeon. Cancers (Basel) 2025;17(9):1476. DOI: 10.3390/cancers17091476

17. Bizoń M., Olszewski M., Grabowska A. et al. Use of the vessel sealer in paraaortic lymphadenectomy in the robotic assisted approach in endometrial cancer. Sci Rep 2025;15(1):8175. DOI: 10.1038/s41598­025­93044­y