Abstract
To compare perioperative outcomes in patients undergoing robotic hysterectomy and extraction of specimen via mini-laparotomy (RHML) versus open hysterectomy (OH) when uterus weighs more than 250 g. To study the factors determining the length of hospital stay in 2 groups. A retrospective analysis of all hysterectomies performed for uterus weighing more than 250 g from the year 2012 to 2015 was conducted. A total of 140 patients were divided into 2 groups based on the type of surgery; RHML (n = 82) and OH (n = 58). Mini-laparotomy consisted of a customised incision connecting 2 left lateral port sites for specimen extraction after completing the hysterectomy robotically. Patient factors and perioperative outcomes were compared using Student’s t tests and Chi-square analysis. Mean length of stay (RHML = 1.4 days; OH = 3.4 days), estimated blood loss (EBL) (RHML = 119.9 ml; OH = 547.5 ml) and operative time (RHML = 191.5 min; OH = 162.8 min) were significantly different. No significant differences were noted for patient BMI, age, comorbidities, intraoperative complications, pathology of uterus and uterus weight. Postoperative complications were significantly different between two groups (RHML = 6.0%; OH = 15.5%; p = .021). None of the patients stayed less than 24 h in OH group compared to 59.8% patients in RHML group. Type of procedure (p = .004) and EBL (p = .002) significantly predicted the length of stay. Patients undergoing RHML have significantly shorter length of stay, EBL and postoperative complications than OH. The operative time for RHML was longer than OH, but the overall decreased length of stay overcomes this disadvantage. RHML approach retains the benefits of da Vinci, while simultaneously preserving the specimen.
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References
Boggess JF et al (2009) Perioperative outcomes of robotically assisted hysterectomy for benign cases with complex pathology. Obstet Gynecol 114(3):585–593
Visco AG, Advincula AP (2008) Robotic gynecologic surgery. Obstet Gynecol 112(6):1369–1384
Holloway RW, Patel SD, Ahmad S (2009) Robotic surgery in gynecology. Scand J Surg 98(2):96–109
Payne TN, Dauterive FR (2008) A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol 15(3):286–291
ElSahwi KS et al (2012) Comparison between 155 cases of robotic vs. 150 cases of open surgical staging for endometrial cancer. Gynecol Oncol 124(2):260–264
Chen CC, Falcone T (2009) Robotic gynecologic surgery: past, present, and future. Clin Obstet Gynecol 52(3):335–343
Advincula AP, Wang K (2009) Evolving role and current state of robotics in minimally invasive gynecologic surgery. J Minim Invasive Gynecol 16(3):291–301
Reza M et al (2010) Meta-analysis of observational studies on the safety and effectiveness of robotic gynaecological surgery. Br J Surg 97(12):1772–1783
Taylan E et al (2017) Contained morcellation: review of current methods and future directions. Front Surg 4:15
US Food and Drug Administration (USFDA) (2014) UPDATED Laparoscopic uterine power morcellation in hysterectomy and myomectomy: FDA safety communication, USFDA Administration, Editor
Kho KA, Anderson TL, Nezhat CH (2014) Intracorporeal electromechanical tissue morcellation: a critical review and recommendations for clinical practice. Obstet Gynecol 124(4):787–793
Brolmann HA et al (2016) Laparoscopic power morcellation of presumed fibroids. Minerva Ginecol 68(3):352–363
Barron KI et al (2015) Association of the US Food and Drug Administration morcellation warning with rates of minimally invasive hysterectomy and myomectomy. Obstet Gynecol 126(6):1174–1180
Srouji SS, Kaser DJ, Gargiulo AR (2015) Techniques for contained morcellation in gynecologic surgery. Fertil Steril 103(4):e34
Stine JE, Clarke-Pearson DL, Gehrig PA (2014) Uterine morcellation at the time of hysterectomy: techniques, risks, and recommendations. Obstet Gynecol Surv 69(7):415–425
Kho KA, Brown DN (2016) Surgical treatment of uterine fibroids within a containment system and without power morcellation. Clin Obstet Gynecol 59(1):85–92
Falcone T, Walters MD (2008) Hysterectomy for benign disease. Obstet Gynecol 111(3):753–767
Kovac SR (2000) Hysterectomy outcomes in patients with similar indications. Obstet Gynecol 95(6 Pt 1):787–793
Kovac SR, Cruikshank SH (1996) Guidelines to determine the route of oophorectomy with hysterectomy. Am J Obstet Gynecol 175(6):1483–1488
Wright JD et al (2016) Trends in use and outcomes of women undergoing hysterectomy with electric power morcellation. JAMA 316(8):877–878
Benedetti-Panici P et al (1996) Surgery by minilaparotomy in benign gynecologic disease. Obstet Gynecol 87(3):456–459
Muzii L et al (2007) Laparoscopic-assisted vaginal hysterectomy versus minilaparotomy hysterectomy: a prospective, randomized, multicenter study. J Minim Invasive Gynecol 14(5):610–615
Glasser MH (2005) Minilaparotomy myomectomy: a minimally invasive alternative for the large fibroid uterus. J Minim Invasive Gynecol 12(3):275–283
Dorsey JH et al (1996) Costs and charges associated with three alternative techniques of hysterectomy. N Engl J Med 335(7):476–482
Pasic RP et al (2010) Comparing robot-assisted with conventional laparoscopic hysterectomy: impact on cost and clinical outcomes. J Minim Invasive Gynecol 17(6):730–738
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Natasha Gupta, Shanti Mohling, Rebecca Mckendrick M.Sc, Rayan Elkattah, Jenny Holcombe, Robert S. Furr, Todd Boren and Stephen DePasquale declare that they have no conflict of interest.
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Gupta, N., Mohling, S., Mckendrick, R. et al. Perioperative outcomes of robotic hysterectomy with mini-laparotomy versus open hysterectomy for uterus weighing more than 250 g. J Robotic Surg 12, 641–645 (2018). https://doi.org/10.1007/s11701-018-0792-7
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DOI: https://doi.org/10.1007/s11701-018-0792-7