Design
We performed an observational cohort study reporting on all patients
treated consecutively with robot-assisted laparoscopy for early stage
cervical cancer (FIGO stage IA1, IA2, IB1 and IIA1 according to 2009
FIGO staging and guidelines23) between 1 December 2007
and 1 April 2017. Inclusion criteria were a histopathologically proven
carcinoma of the cervix and the intention to perform robot-assisted
radical surgery as primary treatment. Patients were excluded in case of
an ongoing pregnancy or when treated with neoadjuvant chemotherapy. All
procedures were part of standard clinical care, for which informed
consent was obtained.
The primary outcome of interest was surgical proficiency, based on
cervical recurrence rate. Secondary outcomes were disease-free survival
(DFS), disease-specific survival (DSS) and overall survival (OS) in the
different learning phases. Survival was defined as the time interval
between date of diagnosis or first visit and date of disease recurrence
diagnosis (DFS) or death due to the sequelae of cervical cancer (DSS) or
death from any cause (OS).