Comparison of Robotic and Laparoscopic Hysterectomy for the Large Uterus

Overview

Journal JSLS

Specialty General Surgery

Date 2019 Jan 25

PMID 30675091

Citations 12

Authors

Rooma Sinha

Rupa Bana

Madhumathi Sanjay

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: We compared the outcome of robotic hysterectomy (RH) with laparoscopic hysterectomy (LH) for large uteri (≥16 weeks).

Methods: This was a retrospective review over 5 years of 165 women (RH, 46; LH, 119). Demographic data, conversion, hemoglobin drop, indication, operating time, postoperative stay, and intra-operative strategies (adhesiolysis, myomectomy) were recorded.

Results: Mean age was 45.7 ± 6.4 years and 44.5 ± 5.4 years (no diff) and body mass index was 30.2 ± 6.3 kg/m and 27.8 ± 4.8 kg/m ( = .009) in the RH and LH groups. There was no difference in percentage of women with previous laparotomy (RH, 15.2% vs LH, 13.4%) and mean number of lower-segment caesarean section (RH, 1.0 vs LH, 0.8). Mean size of uterus was similar (RH, 20.0 weeks vs LH, 17.4 weeks). The mean number of ports was higher in the RH group (RH, 4.2 vs LH, 3.4; < .001) as was needed for adhesiolysis (RH, 71.7% vs LH, 35.3%; < .001). Difficult bladder dissection was more in the RH group (56.5% vs 26.1%; < .001). Vaginal morcellation was similar in both groups (RH, 89.1%; LH, 83.2%). RH took longer operating time (131.0 vs 110.6 minutes; = .006). RH had less drop in Hb (1.0 vs 1.8 g/dL; < .001) and remained the same after multiple regression analysis. Postoperative stay was similar in both groups (1.4 days). Requirement of intravenous analgesia was significantly lower in the RH group (12.5 vs 30.9 hours; < .001). Open conversion rate was 4.3% (RH) and 10.9% (LH) but not significant.

Conclusion: A higher body mass index, more adhesiolysis, and difficult bladder dissection imply a more challenging nature of women who underwent RH. Despite this, RH was shown to be feasible and safe with a lower blood loss.

Citing Articles

Robotic Surgery for Benign Hysterectomy: A Real-World Study From India.

Patel R, Patel R Cureus. 2025; 16(12):e74932.

PMID: 39744269 PMC: 11688517. DOI: 10.7759/cureus.74932.

Hysterectomy for Large Uterus by Minimally Invasive Surgery (MIS).

Wang P, Uzianbaeva L, Hughes N, Mehdizadeh A JSLS. 2024; 28(3).

PMID: 39445072 PMC: 11495860. DOI: 10.4293/JSLS.2024.00017.

Charting Proficiency: The Learning Curve in Robotic Hysterectomy for Large Uteri Exceeding 1000 g.

Lee J, Kim S J Clin Med. 2024; 13(15).

PMID: 39124614 PMC: 11312725. DOI: 10.3390/jcm13154347.

How does robotic surgery affect gynecology patient care?.

Arslan S, Vehvilainen-Julkunen K, Parviainen A J Robot Surg. 2024; 18(1):256.

PMID: 38896293 PMC: 11186900. DOI: 10.1007/s11701-024-01955-1.

Effect of Uterine Weight on the Surgical Outcomes of Robot-Assisted Hysterectomy in Benign Indications.

Higuchi N, Kanno K, Ochi Y, Sawada M, Sakate S, Yanai S Cureus. 2024; 16(3):e56602.

PMID: 38646385 PMC: 11031623. DOI: 10.7759/cureus.56602.

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