Comparison of surgical outcomes between robot-assisted and conventional laparoscopic hysterectomy for large uterus.

Abstract

We compared the effectiveness of conventional total laparoscopic hysterectomy (TLH) against robot-assisted total hysterectomy (RAH) in patients with a large uterus. According to the subtype of minimally invasive hysterectomy performed for benign indications, the patients (n = 843) were grouped as follows: TLH (n = 340) and RAH (n = 503). The median operative time (OT) for TLH was 98min (47-406min), and the estimated blood loss (EBL) was 50mL (5-1800mL). The median OT for RAH was 90min (43-251min), and the EBL was 5mL (5-850mL), with a significantly shorter OT and a lower EBL in RAH than in TLH. Uterine weight was categorized into four groups in increments of 250g. The number of cases in each group was 163 (< 250g), 116 (250-500g), 41 (500-750g), and 20 (≥ 750g) for TLH, and 308 (< 250g), 137 (250-500g), 33 (500-750g), and 25 (≥ 750g) for RAH. In patients with a uterus < 250g, there was no significant difference in OT between TLH and RAH, but in patients with a uterus ≥ 250g, OT tended to be shorter with RAH, which was also true for a uterus ≥ 750g. The EBL was significantly lower with RAH compared to TLH, regardless of uterine weight. In patients with a large uterus, the advantages of robotic surgery can be utilized, which may lead to a shorter OT and less EBL.