Robotic-Assisted Total Laparoscopic Hysterectomy Versus Conventional Total Laparoscopic Hysterectomy

Advocate Illinois Masonic Medical Center, Department of Obstetrics and Gynecology, Chicago, 60657, USA.
JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons (Impact Factor: 0.91). 01/2009; 13(3):364-9.
Source: PubMed


To compare patient characteristics, operative variables, and outcomes of 24 patients who underwent robotic-assisted total laparoscopic hysterectomy (TLH) with 44 patients who underwent conventional TLH. We retrospectively reviewed the charts of 44 patients with TLH and 24 patients with robotic TLH.
Robotic TLH was associated with a shorter hospital stay (1.0 vs 1.4 days, P=0.011) and a significant decrease in narcotic use (1.2 vs 5.0 units, P=0.002). EBL and droP in hemoglobin were not significantly different. The operative time was significantly longer in patients undergoing robotic TLH (142.2 vs 122.1 minutes, P=0.027). However, only need for laparoscopic morcellation, BMI, and uterine weight, not robotic use, were independently associated with increased operative times.
Robotic hysterectomy can be performed safely with comparable operative times to those of conventional laparoscopic hysterectomy. Postoperative measures were improved over measures for conventional laparoscopy.

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    • "Although length of hospital stay may be influenced by institutional policy, clearly all studies favor robotic hysterectomy with an average of 1 less day of hospitalization, although some reports indicate no difference.15,17,19–21 One study by Shashoua et al also evaluated narcotic usage and found that the robotic procedures required fewer units (1.2 vs 5.0 U, P = .002).18 Most authors report a significantly diminished incidence in laparotomy conversions as well as complications, which if encountered, were quite similar to those found in conventional laparoscopy.16,19,20,22,23 "
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    ABSTRACT: Robotic laparoscopy in gynecology, which started in 2005 when the Da Vinci Surgical System (Intuitive Surgical Inc) was approved by the US Food and Drug Administration for use in gynecologic procedures, represents today a modern, safe, and precise approach to pathology in this field. Since then, a great deal of experience has accumulated, and it has been shown that there is almost no gynecological surgery that cannot be approached with this technology, namely hysterectomy, myomectomy, sacrocolpopexia, and surgery for the treatment of endometriosis. Albeit no advantages have been observed over conventional laparoscopy and some open surgical procedures, robotics do seem to be advantageous in highly complicated procedures when extensive dissection and proper anatomy reestablishment is required, as in the case of oncologic surgery. There is no doubt that implementation of better logistics in finance, training, design, and application will exert a positive effect upon robotics expansion in gynecological medicine. Contrary to expectations, we estimate that a special impact is to be seen in emerging countries where novel technologies have resulted in benefits in the organization of health care systems.
    Preview · Article · Jul 2013
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    • "The authors state however that the last 25 robotic cases (of 100) were done faster than the average total laparoscopic hysterectomy (92.4 minutes vs. 78.7 minutes). Other studies that had longer operative times for the robotic cohort, include the studies from Shashoua et al. [10], 2009 and Nezhat et al. [11], 2009 where there was an increased operative time of 20, and 70 minutes respectively. "
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    ABSTRACT: To compare the outcomes of total laparoscopic to robotic approach for hysterectomy and all indicated procedures after controlling for surgeon and other confounding factors. Retrospective chart review of all consecutive cases of total laparoscopic and da Vinci robotic hysterectomies between August 2007 and July 2009 by two gynecologic oncology surgeons. Our primary outcome measure was operative procedure time. Secondary measures included complications, conversion to laparotomy, estimated blood loss and length of hospital stay. A mixed model with a random intercept was applied to control for surgeon and other confounders. Wilcoxon rank-sum, chi-square and Fisher's exact tests were used for the statistical analysis. The 124 patients included in the study consisted of 77 total laparoscopic hysterectomies and 47 robotic hysterectomies. Both groups had similar baseline characteristics, indications for surgery and additional procedures performed. The difference between the mean operative procedure time for the total laparoscopic hysterectomy group (111.4 minutes) and the robotic hysterectomy group (150.8 minutes) was statistically significant (p=0.0001) despite the fact that the specimens obtained in the total laparoscopic hysterectomy group were significantly larger (125 g vs. 94 g, p=0.002). The robotic hysterectomy group had statistically less estimated blood loss than the total laparoscopic hysterectomy group (131.5 mL vs. 207.7 mL, p=0.0105) however no patients required a blood transfusion in either group. Both groups had a comparable rate of conversion to laparotomy, intraoperative complications, and length of hospital stay. Total laparoscopic hysterectomy can be performed safely and in less operative time compared to robotic hysterectomy when performed by trained surgeons.
    Full-text · Article · Dec 2011 · Journal of Gynecologic Oncology
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    • "While complication rates were similar in the two groups, conversion rates were significantly higher in the conventional laparoscopic cohort. A similar comparative investigation showed that robotic hysterectomy patients had significantly shorter hospital stays but longer operative times than patients who underwent total laparoscopic hysterectomy [9]. To date, no comparative studies of RALH and LSH have been identified in the Medline literature database. "
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    ABSTRACT: The study reported here compares outcomes of three approaches to minimally invasive hysterectomy for benign indications, namely, robotic-assisted laparoscopic (RALH), laparoscopic-assisted vaginal (LAVH) and laparoscopic supracervical (LSH) hysterectomy. The total patient cohort comprised the first 237 patients undergoing robotic surgeries at our hospital between August 2007 and June 2009; the last 100 patients undergoing LAVH by the same surgeons between July 2006 and February 2008 and 165 patients undergoing LAVHs performed by nine surgeons between January 2008 and June 2009; 87 patients undergoing LSH by the same nine surgeons between January 2008 and June 2009. Among the RALH patients were cases of greater complexity: (1) higher prevalence of prior abdominopelvic surgery than that found among LAVH patients; (2) an increased number of procedures for endometriosis and pelvic reconstruction. Uterine weights also were greater in RALH patients [207.4 vs. 149.6 (LAVH; P < 0.001) and 141.1 g (LSH; P = 0.005)]. Despite case complexity, operative time was significantly lower in RALH than in LAVH (89.9 vs. 124.8 min, P < 0.001) and similar to that in LSH (89.6 min). Estimated blood loss was greater in LAVH (167.9 ml) than in RALH (59.0 ml, P < 0.001) or LSH (65.7 ml, P < 0.001). Length of hospital stay was shorter for RALH than for LAVH or LSH. Conversion and complication rates were low and similar across procedures. Multivariable regression indicated that LAVH, obesity, uterine weight ≥250 g and older age predicted significantly longer operative time. The learning curve for RALH demonstrated improved operative time over the case series. Our findings show the benefits of RALH over LAVH. Outcomes in RALH can be as good as or better than those in LSH, suggesting the latter should be the choice primarily for women desiring cervix-sparing surgery.
    Preview · Article · Sep 2010 · Journal of Robotic Surgery
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