title: The use of robot-assisted laparoscopic hysterectomy in the patient with a scarred or obliterated anterior cul-de-sac.
abstract: OBJECTIVE
  The scarred or obliterated anterior cul-de-sac may pose a challenge to hysterectomy by any route. Conventional laparoscopic hysterectomy is fraught with technical limitations that limit the ability to compensate for the altered anatomy. This study will evaluate the feasibility of applying robot-assisted laparoscopy to managing these patients.
  
  
  METHODS
  Six patients with suspected pelvic adhesive disease involving the anterior cul-de-sac underwent robot-assisted laparoscopic hysterectomy for benign indications. Data were collected and analyzed as a retrospective case series analysis.
  
  
  RESULTS
  We attempted 6 robot-assisted laparoscopic hysterectomies with no conversions to laparotomy. The mean uterine weight was 121.7 g (range, 70 to 166.3). Mean operating time was 254 minutes (range, 170 to 368). The average estimated blood loss was 87.5 mL. One patient developed a delayed vaginal cuff hematoma. The average length of hospital stay was 1.3 days.
  
  
  CONCLUSIONS
  Robot-assisted laparoscopic hysterectomy is a feasible technique in patients with a scarred or obliterated anterior cul-de-sac and may provide a tool to overcome the surgical limitations seen with conventional laparoscopy.
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, MI 48109, USA. aadvincu@umich.edu
authors.forename: Arnold P
authors.initials: AP
authors.lastname: Advincula
authors.forename: R Kevin
authors.initials: RK
authors.lastname: Reynolds
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D002921:Cicatrix / Q000150:complications; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D009929:Organ Size; D017699:Pelvic Pain / Q000601:surgery; D010388:Pelvis; D012189:Retrospective Studies; D012371:Robotics / Q000295:instrumentation; D013997:Time Factors; D000267:Tissue Adhesions / Q000150:complications; D014592:Uterine Hemorrhage / Q000601:surgery; D014599:Uterus / Q000473:pathology