Surgical technique
All surgical procedures were performed at a tertiary referral centre by a surgical team consisting of two gynaecological oncologists (RV, RZ) with similar experience in robot-assisted operation techniques. In all patients with early stage cervical cancer and an indication for radical surgery, the da Vinci (S until 2010 and Si until 2017) Surgical System (Intuitive Surgical, Sunnyvale, USA) was used. Robot-assisted laparoscopy was the standard of care, with laparotomy only performed in 10 cases during the inclusion period for those who had an absolute contra-indication (e.g. advanced pregnancy, large uterus).Primary surgical treatment for early stage cervical cancer consisted typically of robot-assisted pelvic sentinel lymph node (SLN) evaluation and systematic lymph node dissection (PLND) combined with radical hysterectomy or radical vaginal trachelectomy when fertility preservation was desired and the maximum tumour diameter was ≤2 cm. When sentinel nodes were found to be positive on frozen section, the intended radical uterine surgery was discontinued and chemoradiation initiated. In case of unexpected finding of cervical cancer after simple hysterectomy (for benign indication), primary treatment was expanded with robot-assisted PLND and parametrectomy. Details on the surgical techniques performed at our institution have been previously described.5,24