LAS VEGAS – Robotic-assisted total laparoscopic hysterectomy produced comparable outcomes to other minimally invasive methods of hysterectomy without increasing the risk for conversion or complications in a retrospective chart analysis of nearly 300 women.
Dr. Mona E. Orady
The data suggested that robotic hysterectomy (RH) may even be associated with a slightly lower risk for blood loss and minor complications, and may be particularly useful in patients with large uterine size or a high body mass index. "Thus, the robot provides an additional tool, allowing a minimally invasive approach to hysterectomies in cases when a surgeon may be tempted to resort to an abdominal approach," said Dr. Mona E. Orady of the Henry Ford Health System, Detroit.
The study population included 297 women who underwent any form of minimally invasive hysterectomy between January 2006 and May 2010 at one of two Henry Ford campuses. Emergent and supracervical hysterectomies were excluded, as were hysterectomies performed for malignancy or concomitantly with urogynecologic procedures.
In all, 135 patients underwent RH procedures and 162 had nonrobotic minimally invasive procedures, including total laparoscopic hysterectomy (TLH), vaginal hysterectomy (VH), or laparoscopic-assisted vaginal hysterectomy (LAVH). The two groups did not differ in age (mean, 45 years), and about two-thirds of each group were black. Body mass index was comparable in the two groups, with fewer than 25% of all patients being at or below normal weight.
However, patients in the robotic group did have significantly larger uteri (mean, 262 g), compared with 197 g for the nonrobotic group, Dr. Orady reported at the annual meeting of the AAGL.
Procedure duration was significantly increased with RH, by a median of 25 minutes longer than the other minimally invasive procedures combined. However, the difference in duration between RH and conventional TLH did not differ significantly (169 vs. 194 minutes). The main difference was in comparison with VH, which had a median of just 98.5 minutes.
Estimated blood loss was significantly less for RH (median, just 50 mL), compared with all of the nonrobotic hysterectomy procedures (150 mL for both TLH and VH; 250 mL for LAVH). This coincided with drops in hemoglobin, "thus confirming that the findings are real and not just perceived," she noted.
Overall length of stay was a median of 1 day for the robotic group and all other minimally invasive groups except LAVH, which had a median stay of 2 days.
Major complication rates (defined as any visceral injury or complication that caused increased hospital stay, readmission, or reoperation) were nearly the same between RH and the other minimally invasive procedures at 11.1% and 10.5%, respectively. However, there were significantly fewer minor complications with RH, compared with the other procedures (8.9% vs. 21.6%), and those consisted primarily of vaginal cuff granulation, cellulitis, or bleeding.
Interestingly, vaginal cuff issues are often attributed to robotic procedures in the literature, Dr. Orady commented.
All attempted robotic TLH procedures were completed, even among obese patients and those with very large uteri. In contrast, three conversions to abdominal procedures occurred with the other minimally invasive procedures: One was secondary to a hemorrhage in a patient with a 780-g uterus, another resulted from an inability to gain intraperitoneal access and visualization in a patient with a BMI of 53 kg/m2, and a third involved an inability to remove a 280-g uterus vaginally.
"The data suggest that the robotic approach may allow surgeons to overcome conversions associated with obesity or extremely large uteri, but further data are required," Dr. Orady concluded.
Dr. Orady stated that she had no financial disclosures.