Robotically Assisted Hysterectomy in Patients With Large Uteri Outcomes in Five Community Practices
ABSTRACT To examine outcomes of robotically assisted laparoscopic hysterectomy in patients with benign conditions involving high uterine weight and complex pathology.
A multicenter study was undertaken in five community practice settings across the United States. All patients who had minimally invasive laparoscopic hysterectomy with robotic assistance March 2006 through July 2009 and uterine weights of at least 250 g were included. Retrospective chart review identified outcomes including skin-to-skin operative time, conversion to an exploratory laparotomy, blood loss, complications, and hospital duration of stay. The effect of uterine weight on skin-to-skin time and blood loss also was examined.
Data were analyzed for 256 patients with uteri weighing 250 to 3,020 g (median 453 g). Most patients were obese or had a history of pelvic or abdominal surgery. Median operative time was 145 minutes. Duration of surgery in patients with uteri 500 g or greater was significantly longer than in patients with uteri less than 500 g (167 compared with 126 minutes, P<.001). Median estimated blood loss also was greater in women with uteri weighing 500 g or more (100 compared with 50 mL, P<.001). Multivariable linear regression analysis confirmed the independent effect of uterine weight on operative time and blood loss. Median duration of hospital stay was 1 day. The conversion rate was 1.6%, the minor complication rate was 1.6%, and major complications occurred in 2.0% of patients.
Women with large uteri may successfully undergo robotically assisted hysterectomy with low morbidity, low blood loss, and minimal risk of conversion to laparotomy. Results were reproducible among general gynecologists from geographically diverse community settings.
- Obstetrics and Gynecology 08/2010; 116(2 Pt 1):441-2; author reply 442. DOI:10.1097/AOG.0b013e3181eafa24 · 4.37 Impact Factor
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ABSTRACT: To determine the incidence of vaginal cuff dehiscence after minimally invasive hysterectomy, we reported our series of total laparoscopic hysterectomies with transvaginal colporraphy. We then conducted a systematic search of PubMed to retrieve published series of laparoscopic and robotic hysterectomies, in which different techniques for vaginal cuff closure were used. In our study group, vaginal cuff dehiscence occurred in 2 of 665 (0.3%) patients. Our literature search identified 57 articles, for a total of 13,030 endoscopic hysterectomies. Ninety-one postoperative vaginal separations were reported (0.66%). The pooled incidence of vaginal dehiscence was lower for transvaginal cuff closure (0.18%) than for both laparoscopic (0.64%; odds ratio [OR], 0.28; 95% confidence interval [CI], 0.12-0.65) and robotic (1.64%; OR, 0.11; 95% CI, 0.04-0.26) colporraphy. Laparoscopic cuff closure was associated with a lower risk of dehiscence than robotic closure (OR, 0.38; 95% CI, 0.28-0.6). Current evidence indicates that transvaginal colporraphy after total laparoscopic hysterectomy is associated with a 3- and 9-fold reduction in risk of vaginal cuff dehiscence compared with laparoscopic and robotic suture, respectively.American journal of obstetrics and gynecology 03/2011; 205(2):119.e1-12. DOI:10.1016/j.ajog.2011.03.024 · 3.97 Impact Factor
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ABSTRACT: Robotic surgery has become an integral part of gynaecological surgery in the U.S.A. In Australia, however, robotic surgery has only been established in urologic and cardiac surgery. In 2008, the Royal Adelaide Hospital (RAH) was the first public hospital to initiate a robotic surgery program in gynaecology and gynaecological oncology in Australia. To evaluate the feasibility and outcome of the robotic surgery program in gynaecology and gynaecological oncology at the RAH. A prospective case series analysis of the first 71 patients operated by robotic surgery from August 2008 to May 2010 was performed. All patients underwent a total or radical robotic hysterectomy with or without staging for gynaecological cancer, benign disease or genetic risk. No conversions to laparotomy were required. Sixty-seven patients (95%) were discharged the morning after surgery. Four patients (5%) required hospital stays of up to 3 days because of pre-existing medical conditions or logistical reasons. The only major postoperative complication was one vault dehiscence. Minor short-term problems in four patients were vaginal cuff cellulitis, vaginal vault granulation tissue and infected port sites. The RAH experience is that robotic surgery in gynaecology and gynaecological oncology is safe and feasible. Patient recovery is excellent, and the hospital stay is reduced. Robotic surgery has the potential to significantly expand the minimally invasive surgical options for women undergoing surgery for benign and malignant gynaecological disease in Australia.Australian and New Zealand Journal of Obstetrics and Gynaecology 04/2011; 51(2):119-24. DOI:10.1111/j.1479-828X.2011.01293.x · 1.62 Impact Factor