{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T23:53:04Z","timestamp":1783036384272,"version":"3.54.6"},"reference-count":30,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T00:00:00Z","timestamp":1765065600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"publisher","award":["RPMP.01.02.01-12-0070\/20-00"],"award-info":[{"award-number":["RPMP.01.02.01-12-0070\/20-00"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Cervical cancer remains a major cause of cancer-related morbidity and mortality among women worldwide. The introduction of total mesometrial resection (TMMR), based on the ontogenetic compartment theory, has redefined the concept of surgical radicality in cervical cancer treatment. This study aimed to evaluate the perioperative, histopathological, and early oncologic outcomes of TMMR performed using the da Vinci Xi robotic system in patients with early-stage cervical carcinoma. Methods: A pilot, prospective, single-center study was conducted between 2021 and 2023 and included 20 consecutive patients diagnosed with F\u00e9d\u00e9ration Internationale de Gyn\u00e9cologie et d\u2019Obst\u00e9trique (FIGO) stage IA2\u2013IIA1 cervical carcinoma. All patients underwent robotic surgery: 4 classic radical robotic hysterectomies, 12 radical robotic hysterectomies using the TMMR technique with pelvic lymphadenectomy, and\u2014given the young age of selected patients, fertility considerations, and tumor characteristics\u20144 radical trachelectomies. Surgical parameters, histopathological data, and 24-month follow-up outcomes were analyzed. Statistical analyses included Spearman\u2019s correlation, Fisher\u2019s exact test, and Mann\u2013Whitney U test, with p &lt; 0.05 considered statistically significant. Results: All procedures were completed robotically without conversion to laparotomy. The mean operative time was 178 \u00b1 42 min, mean blood loss 112 \u00b1 61 mL, and mean hospital stay 4.2 \u00b1 1.6 days. No intraoperative complications occurred. Minor postoperative complications (Clavien\u2013Dindo grade I\u2013II) were observed in 10% of cases. Negative surgical margins (R0) were achieved in 17 cases, while positive margins (R+) were observed in 4 cases. Lymph node metastases were present in 20.0% of patients, and both lymphovascular space invasion (LVSI) and Vascular Endothelial Growth Factor (VEGF) expression were detected in 33.3%. No significant correlations were found between VEGF expression, LVSI, or nodal status. During the 24-month follow-up period, no local or distant recurrences were documented. Conclusions: Robotic TMMR for early-stage cervical cancer is feasible, safe, and provides complete oncologic radicality with low perioperative morbidity. Although these preliminary results are promising, larger multicenter studies are needed to validate long-term oncologic outcomes and to establish standardized protocols for robotic compartment-based surgery.<\/jats:p>","DOI":"10.3390\/jcm14248667","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:20:29Z","timestamp":1765210829000},"page":"8667","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes of Cervical Cancer Treatment Using Total Mesometrial Resection (TMMR) Performed with the Robotic System\u2014A Preliminary Report"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8395-279X","authenticated-orcid":false,"given":"Marcin","family":"Op\u0142awski","sequence":"first","affiliation":[{"name":"Department of Gynecology and Obstetrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krak\u00f3w University, 30-705 Cracow, Poland"},{"name":"Department of Gynecology, Neo Hospital, 30-437 Cracow, Poland"},{"name":"Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, 31-820 Cracow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krzysztof","family":"Mawlichan\u00f3w","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Neo Hospital, 30-437 Cracow, Poland"},{"name":"Bioethics and Medical Law Department, Andrzej Frycz Modrzewski Krak\u00f3w University, 30-705 Cracow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnieszka","family":"Golec-Cera","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Neo Hospital, 30-437 Cracow, Poland"},{"name":"Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, 31-820 Cracow, Poland"},{"name":"Bioethics and Medical Law Department, Andrzej Frycz Modrzewski Krak\u00f3w University, 30-705 Cracow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Jedrzejczyk","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krak\u00f3w University, 30-705 Cracow, Poland"},{"name":"Department of Gynecology, Neo Hospital, 30-437 Cracow, Poland"},{"name":"Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, 31-820 Cracow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazimierz","family":"Pitynski","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Neo Hospital, 30-437 Cracow, Poland"},{"name":"Department of Gynecology and Oncology, Jagiellonian University Medical College, 31-501 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8797-1894","authenticated-orcid":false,"given":"Radovan","family":"Pilka","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Neo Hospital, 30-437 Cracow, Poland"},{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, 779 00 Olomouc, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e197","DOI":"10.1016\/S2214-109X(22)00501-0","article-title":"Global Estimates of Incidence and Mortality of Cervical Cancer in 2020: A Baseline Analysis of the WHO Global Cervical Cancer Elimination Initiative","volume":"11","author":"Singh","year":"2023","journal-title":"Lancet Glob. Health"},{"key":"ref_2","first-page":"e1756","article-title":"Global, Regional and National Burden, Incidence, and Mortality of Cervical Cancer","volume":"6","author":"Momenimovahed","year":"2023","journal-title":"Cancer Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1136\/ijgc-2020-001285","article-title":"World Health Organization Call for Action to Eliminate Cervical Cancer Globally","volume":"30","author":"Gultekin","year":"2020","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Choi, S., Ismail, A., Pappas-Gogos, G., and Boussios, S. (2023). HPV and Cervical Cancer: A Review of Epidemiology and Screening Uptake in the UK. Pathogens, 12.","DOI":"10.3390\/pathogens12020298"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1080\/14737159.2025.2486653","article-title":"Evolution and Future of Cervical Cancer Screening: From Cytology to Primary HPV Testing and the Impact of Vaccination","volume":"25","author":"Franco","year":"2025","journal-title":"Expert Rev. Mol. Diagn."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"25151355251356646","DOI":"10.1177\/25151355251356646","article-title":"Cervical Cancer Trends, HPV Vaccine Utilization, and Screening in Low- and Lower-Middle-Income Countries: An Updated Review","volume":"13","author":"Hamid","year":"2025","journal-title":"Ther. Adv. Vaccines Immunother."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1136\/ijgc-2023-004429","article-title":"ESGO\/ESTRO\/ESP Guidelines for the Management of Patients with Cervical Cancer\u2014Update 2023","volume":"33","author":"Cibula","year":"2023","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Sznurkowski, J.J., Bodnar, L., Szylberg, \u0141., Zo\u0142ciak-Siwinska, A., Da\u0144ska-Bidzi\u0144ska, A., Klasa-Mazurkiewicz, D., Rychlik, A., Kowalik, A., Streb, J., and Bidzi\u0144ski, M. (2024). The Polish Society of Gynecological Oncology Guidelines for the Diagnosis and Treatment of Cervical Cancer (V2024.0). J. Clin. Med., 13.","DOI":"10.3390\/jcm13154351"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1148\/rg.2020200013","article-title":"2018 FIGO Staging Classification for Cervical Cancer: Added Benefits of Imaging","volume":"40","author":"Salib","year":"2020","journal-title":"Radiographics"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1055\/s-0041-1735502","article-title":"Imaging in Carcinoma Cervix and Revised 2018 FIGO Staging System: Implications in Radiology Reporting","volume":"31","author":"Dhamija","year":"2021","journal-title":"Indian J. Radiol. Imaging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1111\/jog.16075","article-title":"Trends of Minimally Invasive Surgery in the Primary Treatment of Cervical Cancer","volume":"50","author":"Baba","year":"2024","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2741","DOI":"10.1200\/JCO.23.02335","article-title":"LACC Trial: Final Analysis on Overall Survival Comparing Open Versus Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer","volume":"42","author":"Ramirez","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.ygyno.2022.07.002","article-title":"The MEMORY Study: MulticentEr Study of Minimally Invasive Surgery versus Open Radical hYsterectomy in the Management of Early-Stage Cervical Cancer: Survival Outcomes","volume":"166","author":"Leitao","year":"2022","journal-title":"Gynecol. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1136\/ijgc-2019-000558","article-title":"Robot-Assisted Approach to Cervical Cancer (RACC): An International Multi-Center, Open-Label Randomized Controlled Trial","volume":"29","author":"Falconer","year":"2019","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.3802\/jgo.2022.33.e9","article-title":"Total Mesometrial Resection (TMMR) for Cervical Cancer FIGO IB\u2013IIA: First Results from the Multicentric TMMR Register Study","volume":"33","author":"Buderath","year":"2021","journal-title":"J. Gynecol. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Li, Y., Na, J., Wang, X., Han, S., and Wang, J. (2024). Robot-Assisted M\u00fcllerian Compartment Resection for Cervical Cancer. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1466921"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Chang, T.P., Chok, A.Y., Tan, D., Rogers, A., Rasheed, S., Tekkis, P., and Kontovounisios, C. (2021). The Emerging Role of Robotics in Pelvic Exenteration Surgery for Locally Advanced Rectal Cancer: A Narrative Review. J. Clin. Med., 10.","DOI":"10.3390\/jcm10071518"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1136\/ijgc-2020-001506","article-title":"SUCCOR Study: An International European Cohort Observational Study Comparing Minimally Invasive Surgery versus Open Abdominal Radical Hysterectomy in Patients with Stage IB1 Cervical Cancer","volume":"30","author":"Chiva","year":"2020","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1001\/jamaoncol.2020.1694","article-title":"Survival After Minimally Invasive vs. Open Radical Hysterectomy for Early-Stage Cervical Cancer: A Systematic Review and Meta-Analysis","volume":"6","author":"Nitecki","year":"2020","journal-title":"JAMA Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e72","DOI":"10.3802\/jgo.2025.36.e72","article-title":"Gynecologic Oncology in 2024: Breakthrough Trials and Evolving Treatment Strategies for Cervical, Uterine Corpus, and Ovarian Cancers","volume":"36","author":"Lee","year":"2025","journal-title":"J. Gynecol. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1016\/S1470-2045(05)70324-7","article-title":"Association between the Mesenchymal Compartment of Uterovaginal Organogenesis and Local Tumour Spread in Stage IB-IIB Cervical Carcinoma: A Prospective Study","volume":"6","author":"Horn","year":"2005","journal-title":"Lancet Oncol."},{"key":"ref_22","first-page":"4616343","article-title":"Robotic Compartment-Based Radical Surgery in Early-Stage Cervical Cancer","volume":"2016","author":"Toptas","year":"2016","journal-title":"Case Rep. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1186\/1477-7819-11-198","article-title":"Definition of Compartment-Based Radical Surgery in Uterine Cancer: Modified Radical Hysterectomy in Intermediate\/High-Risk Endometrial Cancer Using Peritoneal Mesometrial Resection (PMMR) by M H\u00f6ckel Translated to Robotic Surgery","volume":"11","author":"Kimmig","year":"2013","journal-title":"World J. Surg. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Eoh, K.J., Kim, T.-J., Park, J.-Y., Kim, H.S., Paek, J., and Kim, Y.T. (2023). Robot-Assisted versus Conventional Laparoscopic Surgery for Endometrial Cancer: Long-Term Comparison of Outcomes. Front. Oncol., 13.","DOI":"10.3389\/fonc.2023.1219371"},{"key":"ref_25","first-page":"3031","article-title":"Expression of VEGF and HIF-1\u03b1 in Locally Advanced Cervical Cancer: Potential Biomarkers for Predicting Preoperative Radiochemotherapy Sensitivity and Prognosis","volume":"9","author":"Zhu","year":"2016","journal-title":"OncoTargets Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1007\/s00432-020-03225-7","article-title":"Prognostic Significance of VEGF and Components of the Plasminogen Activator System in Endometrial Cancer","volume":"146","author":"Abbink","year":"2020","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Tantari, M., Bogliolo, S., Morotti, M., Balaya, V., Bouttitie, F., Buenerd, A., Magaud, L., Lecuru, F., Guani, B., and Mathevet, P. (2022). Lymph Node Involvement in Early-Stage Cervical Cancer: Is Lymphangiogenesis a Risk Factor? Results from the MICROCOL Study. Cancers, 14.","DOI":"10.3390\/cancers14010212"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1016\/S1470-2045(09)70100-7","article-title":"Resection of the Embryologically Defined Uterovaginal (M\u00fcllerian) Compartment and Pelvic Control in Patients with Cervical Cancer: A Prospective Analysis","volume":"10","author":"Horn","year":"2009","journal-title":"Lancet Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"102696","DOI":"10.1016\/j.eclinm.2024.102696","article-title":"Oncologic Outcomes after Total Mesometrial Resection (TMMR) or Treatment According to Current International Guidelines in FIGO (2009) Stages IB1-IIB Cervical Cancer: An Observational Cohort Study","volume":"73","author":"Falconer","year":"2024","journal-title":"EClinicalMedicine"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1016\/S1470-2045(19)30389-4","article-title":"Surgical Resection Based on Ontogenetic Cancer Field Theory for Cervical Cancer: Mature Results from a Single-Centre, Prospective, Observational, Cohort Study","volume":"20","author":"Wolf","year":"2019","journal-title":"Lancet Oncol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8667\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:50:16Z","timestamp":1765212616000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8667"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,7]]},"references-count":30,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14248667"],"URL":"https:\/\/doi.org\/10.3390\/jcm14248667","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,7]]}}}