Impact of uterine weight on robotic hysterectomy: Analysis of 500 cases in a single institute

Abstract

Backgrounds Robotic surgeries have been used frequently for benign diseases in gynecology. However, the advantage of robotic surgery for huge uterus is unclear. Methods We analyzed surgical outcomes of 527 patients who underwent robotic hysterectomies for benign diseases, separating uterine sizes into five groups by every 250 g. Results Median operative time in the five groups was 123 minutes (<250 g), 130 minutes (250‐500 g), 144 minutes (500‐750 g), 180 minutes (750‐1000 g), and 170 minutes (>1000 g). Median estimated blood loss was 50, 100, 100, 200, and 400 mL in the five groups, respectively. The incidence of intraoperative complications did not correlate with uterine weight. Conclusions Operative time, estimated blood loss, and the incidence of conversion to laparotomy increased with uterine size during robotic hysterectomies, especially evident in a uterus >750 g.

Robotic-Assisted Hysterectomy for Benign Indications of Uteri Less Than Fourteen Weeks Size Versus More Than Fourteen Weeks Size: A Comparative Study

“…Patients were divided into five groups based on uterine size: <250 g, 250-500 g, 500-750 g, 750-1000 g, and >1000 g. Estimated blood loss and operating time showed a linear relationship with uterine size (p-value<0.001). The blood loss during surgery was more in a group with uterus weight >1000 g [ 15 ]. Similar to the study by Akazawa et al, we also found that mean blood loss and operating time increased as the size of the uterus increased.…”

“…In our study, totally nine patients had intra-operative and post-operative complications and this was similar in both groups (p < 0.48). Akazawa et al in 2019 studied the outcome of robotic hysterectomy in 527 patients who had 18 cases (3.4%) with postoperative complications [ 15 ]. Petersen et al in 2018 studied urologic injury with a robotic hysterectomy and observed urologic injury in 0.92% of cases [ 18 ].…”

“…Robotic hysterectomy in women with a large uterus is a suitable approach in the narrow region of the pelvis. Akazawa et al in 2019, conducted a retrospective study on the impact of uterine weight and its outcome in robotic hysterectomy. They analysed the surgical outcomes in 527 patients who had a robotic hysterectomy performed for benign indications.…”

“…Payne et al studied the impact of uterine weight on surgical outcomes on 256 patients undergoing robotic hysterectomy based on the division of cases into two groups less than 500 g and more than 500 g and concluded that blood loss and operating time increased as the size of the uterus increased [ 14 ]. Akazawa et al analysed the surgical outcome of 527 patients of robotic hysterectomy after separating them into five groups and observed an increase in operating time and blood loss as uterine size increased [ 15 ]. Tyan et al reported robotic hysterectomy as a safe and feasible option for benign cases across a range of uterine weights [ 16 ].…”

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

“…Uterine weight, in particular, varies from a small uterus to a large uterus weighing more than 1 kg [3,4], depending on the indications. Most previous studies have reported that surgical difficulty increases with increasing uterine weight, suggesting that uterine weight affects surgical outcomes, such as operative time, blood loss, and conversion to laparotomy [5][6][7][8]. However, the impact of uterine weight on the surgical outcomes of robot-assisted hysterectomy has not been elucidated, with previous studies showing disparate results.…”