Does size matter? The effect of uterine weight on robot-assisted total laparoscopic hysterectomy outcomes

Abstract

The objective of this study was to determine whether uterine weight affects the surgical outcomes of robot-assisted total laparoscopic hysterectomy (RH) procedures. The design of this study is retrospective cohort study. The classification of the study design is level II-2 evidence. The study setting is the Henry Ford Health System's Community Teaching Hospitals. One-hundred and thirty-five patients underwent RH for benign indications at one of two hospitals between January1, 2008, and June 1, 2010. Interventions were scheduled RH without concomitant uro-gynecologic procedures as the intention to treat. Patient demographics, age, height, weight, estimated blood loss (EBL), procedure duration, uterine weight, pathology, length of hospital stay (LOS), and any complications were obtained from a detailed review of electronic medical records. Uterine weight ranged from 47 to 1,290 g (<250 g, n = 87; 250-500 g, n = 28; >500 g, n = 18). Overall, uterine weight was highly correlated with procedure duration (r = .53, P < .001.). Median procedure duration increased from 150 min for the <250 g group, to 205 min for the 250-500 g group, and to 295 min for the >500 g group. Uterine weight was also moderately correlated with EBL (r = .30, P = .0005). Median EBL increased from 50 ml for uteri <250 g to 87.5 ml for the 250-500 g group, and 100 ml for the >500 g group. This correlation did not persist in the assessment of decrease in peri-operative hemoglobin (r = .09, P = .30). Ninety-one women had a LOS of 1 day (67.4%), 31 women had a LOS of 2 days (23%), and 13 women had a LOS of greater than 2 days (9.6%). Uterine weight was not correlated with LOS (r = .14, P = .10) and was not associated with increased major or minor complications (WRS P = .79) re-admission (WRS P = .35), or blood transfusion (n = 3). RH can be performed on patients with large uteri exceeding 500 g without associated adverse outcomes. Although procedure duration is increased, there is no significant effect on EBL and no increase in the occurrence of complications or length of stay.

Comparison of Robotic-Assisted Hysterectomy to Other Minimally Invasive Approaches

“…However, women who underwent robotic hysterectomy had statistically significantly larger uteri, with a larger proportion of patients with uteri > 500 g. Several other studies have discussed the advantages of the robotic approach in complex hysterectomy and in hysterectomy for patients with larger uterine weight. 10,17,18 These studies have also shown that the robotic approach allows for completion of TLH with robotic assistance in patients with large BMI, thus suggesting a possible advantage to the robotic approach in these more complex procedures. 19 …”

Hysterectomy in benign conditions: a 20-year single-center retrospective on the development of surgical techniques

“…Especially in obese women, the benefits of robot surgery compared to conventional laparoscopy have been demonstrated [14]. In addition, in the case of large uterus size [15][16][17], reduced blood loss, reduced postoperative pain and shorter hospitalization with higher surgery costs were shown. However, most of these studies are not randomized and the results are heterogeneous.…”

Robotic Hysterectomy for Benign Indications: What Have We Learned from a Decade?

“…Our results match existing data supporting a significant increase in EBL with larger uteri with no increase in the length of stay nor the mortality and morbidity rate. 6 , 16 , 17 …”

“… 7 – 10 However, in complex cases including obesity and large uteri, robotic surgery have shown a benefit. 11 – 16 Robotic surgery demonstrated a rapid adoption in minimally invasive hysterectomy because of the shorter learning curve. 17 , 18 The increase in minimally invasive surgery attributed to robotic surgery could be one of the most interesting aspects of its use, especially for benign conditions, offering patients shorter hospital stay, smaller incisions, less postoperative pain, and fewer complications when compared to laparotomy.…”