Abstract
ObjectivesThis study was conducted to evaluate the feasibility of robotic hysterectomy for benign indications in patients with small size (<14 weeks) versus large size (>14 weeks) uterus.MethodsThis prospective study was conducted in a single centre from August 2018 to January 2020 in the Department of Obstetrics and Gynecology at All India Institute of Medical Sciences, Rishikesh (Uttarakhand). Surgical outcomes of 216 patients who underwent a robotic hysterectomy in our institution for benign indications were analysed. Women opting for definitive surgical management by minimally invasive technique were divided into two groups according to the size of the uterus less than 14 weeks (group 1) versus more than equal to 14 weeks (group 2). Data collected in both groups included intra-operative and post-operative parameters, length of hospital stay and morbidity if any.ResultsThe demographic profile was comparable in both groups. The mean estimated blood loss was 180.78 ±68.0 ml (range, 10-340 ml) in group 1 and 253.49 ±57ml (range, 60-360 ml) in group 2 (p-value < 0.0001). However, the fall in haemoglobin level after 24 hours of surgery was not statistically significantly different between the two groups. The total duration of surgery in group 1 was 97.86 ± 12.0 minutes (range, 78-132 minutes) and in group 2 was 116.60 ± 15.4 minutes (range, 97-156 minutes), the difference being statically significant (p-value < 0.0001, 95% CI 103±2.1). Console time in group 1 was 43.84 ±6.0 minutes (range, 34-57 minutes) and in group 2 53.22 ±5.5 minutes (range, 44-66 minutes), the difference being statistically significant (p-value < 0.0001, 95% CI 46.57±0.97). There was no difference observed in terms of intra-operative and post-operative complications between the two groups.ConclusionThe total duration of surgery and estimated blood loss were directly proportional to the size of the uterus. However, complication rate, hospital stay and requirement of post-op analgesia were comparable in both groups. Robotic surgery in a larger uterus is a feasible option in terms of better surgical outcomes and postoperative course. Thus, robotic hysterectomy in women with a large uterus is a suitable approach in the narrow region of the pelvis.
Highlights
Hysterectomy for benign diseases is the most common gynaecological surgery performed worldwide [1,2]
Difficulties encountered during laparoscopic surgeries in large uterine sizes like limited access to the vascular pedicle and restricted uterine manoeuvrability are better handled with a robotic approach
We report the outcome of benign robotic hysterectomy in a larger uterus as compared to a small-sized uterus
Summary
Hysterectomy for benign diseases is the most common gynaecological surgery performed worldwide [1,2]. More than 50% of hysterectomies are being performed via abdominal approach currently, but gradually the trend is shifting towards minimally invasive surgery as it offers the advantage of lesser blood loss, less postop pain, early mobilization, faster recovery, shorter duration of hospital stay, and reduced patient morbidity [4,5]. The advantages offered by robotic-assisted surgery include seven degrees of movement along with elimination of hand tremors, endo-wrist movements, flexible movements thereby eliminating fulcrum effect of laparoscopy, stable camera, clear surgical three-dimensional (3D) stereoscopic view of the surgical field and increased independence to operating surgeon with a shorter learning curve [7,8,9]. The disadvantages include high cost and lack of tactile feedback while working in restricted operating fields such as the human pelvis [10,11,12]
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