How to Complete a Gynecological Robot-Assisted Retroperitoneal Lymph Node Dissection with a High-Quality Experience: 180 Cases in a Single Center.

Background: This study seeks to provide a comprehensive overview of robotic retroperitoneal lymphadenectomy in patients with endometrial cancer, including surgical techniques, quality enhancement, and complication reduction. Methods: A cohort of 180 endometrial cancer patients who underwent retroperitoneal lymphadenectomy with the Da Vinci robotic surgical system in the gynecology department from November 2017 to June 2023 was compared to 195 patients who underwent laparoscopic retroperitoneal lymphadenectomy during the same period as controls. Results: In surgical interventions, the robotic retroperitoneal lymphadenectomy demonstrated superior results compared to laparoscopic surgery, including shorter surgical duration (165 vs. 180 min, p = 0.03), reduced intraoperative bleeding 45 vs. 65 mL, p = 0.04, lower incidence of postoperative complications 19 vs. 33, p = 0.03, and higher rates of complete lymph node resections 25 vs. 20, p = 0.02. Notably, the robotic approach excelled in the retrieval of high para-aortic lymph nodes, particularly in the superior region of the inferior mesenteric artery 5 vs. 3, p = 0.04. In postoperative recovery, the robot group also exhibited significant advantages over the laparoscopic group in various outcomes, including postoperative anal exhaust time 47 vs. 55, p = 0.02, first time out of bed activity time 8 vs. 9, p = 0.04, postoperative hospital stay 2 vs. 4, p = 0.01, and VAS score 4.0 vs. 4.6, p = 0.04, 2.9 vs. 3.4, p = 0.03, 1.1 vs. 1.8, p = 0.04. In surgical outcomes, there was no statistically significant variance observed between the two groups. Conclusions: Robot retroperitoneal lymphadenectomy still follows the classic surgical steps of oncology principles. Summarizing surgical techniques can effectively improve surgical quality and reduce surgical complications.