Robotic-assisted radical hysterectomy and trachelectomy

The introduction of robotic-assisted laparoscopic surgery (RALS) has changed the practice of gynecologic oncology. Traditionally, the surgical management of early-stage FIGO IA2-IIA cervical cancer consisted of an open radical hysterectomy and bilateral pelvic lymphadenectomy. Over the past several decades, steady advances in laparoscopy and robotic surgery have impacted the practice of gynecologic oncology. Minimally invasive surgery offers several advantages over laparotomy, including shorter hospital stay, smaller incisions, and less blood loss. The addition of a robotic platform allows for 3D visualization and improved dexterity, both which are important when approaching challenging oncological cases. In this chapter, we present our surgical techniques for managing early-stage cervical cancer utilizing a robotic approach. The procedures described include robotic-assisted radical hysterectomy, radical trachelectomy, and pelvic lymphadenectomy. Studies reporting intraoperative and perioperative outcomes of open and minimally invasive radical hysterectomy are compared. Finally, we review recent evidence, controversies, and clinical trials investigating oncological outcomes of early-stage cervical cancer managed by a minimally invasive approach.