8890 Robotic Hysterectomies with Mini-Laparotomies for Enlarged Uteri

Abstract

<h3>Study Objective</h3> Robotic surgical system assistance in hysterectomies has gained significant popularity amongst gynecologists for its ease of employment, improved visualization and minimally invasive approach in attempts to decrease intra-/post-operative complications and improve clinical outcomes. Assessment of clinical outcomes, specifically length of hospitalization and postoperative complication rates, of patients undergoing robotic hysterectomy with the addition of mini-laparotomy and in bag manual morcellation for extraction of enlarged uteri specimen was analyzed. <h3>Design</h3> Retrospective case series analysis of patients who received the treatment in question pooled from a private practice Obstetrics and Gynecology group. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> Surgical database of this private practice was reviewed and analyzed between 2015 and 2021 for patients undergoing this procedure for benign indications with enlarged uteri (namely uterine fibroids) yielding 52 eligible participants. <h3>Interventions</h3> After completion of a robotic-assisted laparoscopic hysterectomy of an enlarged uterus using the standard technique, the resulting specimen which could not easily be delivered vaginally, was placed into a surgical bag, brought through a mini-laparotomy (≤5cm) and manually morcellated to facilitate specimen extraction. <h3>Measurements and Main Results</h3> A total of 52 patients were included in the retrospective analysis revealing a 90.4% (47/52) same day discharges with 5 post-operative admissions; one for uncontrolled blood glucose and four for post-operative pain. The minimum uterine size requiring mini-laparotomy for extraction was found to be 12cm with at least a 366g weight. The average uterine size and weight requiring said intervention were found to be 18cm and 853g, respectively. Complications were also found to be rare with seven total reports of post-operative fever of which 5 pelvic collections were found and three microbiologically confirmed as pelvic abscesses necessitating drainage and parenteral antibiotics. <h3>Conclusion</h3> Mini-laparotomy within bag manual morcellation for enlarged uteri is a beneficial adjunct technique to robotic-assisted laparoscopic hysterectomies allowing the preservation of the benefits of minimally invasive surgery while also maintaining low complication rates.