Comparison of robotic-assisted hysterectomy to other minimally invasive approaches.

OBJECTIVE: To compare surgical outcomes for robotic assisted total laparoscopic hysterectomy (RH) to other minimally invasive hysterectomy (MIH) types, including total laparoscopic hysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy (LAVH), and vaginal hysterectomy (VH). METHODS: Retrospective cohort study of all patients who underwent RH or MIH for benign indications between January 2007 and May 2010 at 2 Henry Ford Health System teaching hospitals. Age, race, body mass index (BMI), procedure duration, estimated blood loss (EBL), peri-operative hemoglobin change, uterine weight, length of hospital stay (LOS), and complications were collected from electronic medical records and were compared between RH and MIH groups. RESULTS: Included in the analysis were 135 RH and 162 MIH cases (n = 34 VH, n = 82 LAVH, n = 46 TLH). There were no differences in age, race, or BMI between groups, but RH patients had significantly larger uteri (P = .007; RH, 13.5%>500g; MIH 4.0%>500g). MIH patients had significantly greater EBL (P < .001) and drop in hemoglobin (P = .02) than RH patients with a 150 mL difference in median EBL (200 mL versus 50 mL) between groups. RH had longer procedure durations than MIH (P = .0002) overall, but not compared to the TLH subgroup. RH patients had a shorter LOS than MIH patients had (P = .02) who had a longer LOS for LAVH patients. Although readmission and major complication rates were similar in both groups, minor adverse events occurred more frequently in the MIH group (21.6%) than the RH group (8.9%) (P = .003). CONCLUSION: RH has comparable surgical outcomes, and possibly decreased blood loss, shorter length of stay, and fewer minor complications than other methods of MIH.

Effect of body mass index on robotic-assisted total laparoscopic hysterectomy.

STUDY OBJECTIVE: To estimate the impact of body mass index (BMI) on the surgical outcomes of patients undergoing robotic-assisted total laparoscopic hysterectomy. DESIGN: Retrospective cohort study. SETTING: Henry Ford Health System academic medical center (Henry Ford and Henry Ford West Bloomfield Hospitals) PATIENTS: A total of 135 patients who underwent scheduled robotic-assisted total laparoscopic hysterectomy for benign indications, without concomitant urogynecologic procedures between January 2008 and June 2010. INTERVENTIONS: Patients underwent robotic-assisted total laparoscopic hysterectomy as the intention to treat. Two cases were converted to laparotomy. MEASUREMENTS & MAIN RESULTS: Electronic medical records of all patients that underwent robotic-assisted total laparoscopic hysterectomy at Henry Ford Health System were reviewed. Data on demographics, BMI (kg/m(2)), estimated blood loss, perioperative hemoglobin change, procedure duration, hospital length of stay, specimen weight, pathology, and postoperative complications were obtained. The women's median age was 45 years (range 30-68), 61.5% were black, and BMI ranged from 14.8-56.2 kg/m2; 23.4% of women were normal weight or less (BMI <25, n = 31), 52.7% of women were obese (BMI >30, n = 70) and 36 of these patients (27.1%) were morbidly obese (BMI ≥35). BMI did not correlate with procedure duration (Spearman r = .12, p = .16), length of stay (Spearman r = .10, p = .24), or estimated blood loss (Spearman r = .12, p =.18). Our analysis did not identify any meaningful associations between BMI and absolute change in hemoglobin. In addition BMI was not associated with an increase in major or minor complications. CONCLUSION: BMI is not associated with blood loss, duration of surgery, length of stay, or complication rates in patients undergoing robotic-assisted total laparoscopic hysterectomy. Robotic assistance may help surgeons overcome adverse outcomes sometimes found in obese patients.

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

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.