title: Perioperative outcomes of robotically assisted hysterectomy for benign cases with complex pathology.
abstract: OBJECTIVE
  To report on the perioperative outcomes after robotically assisted total hysterectomy for benign indications in a large patient population with predominantly complex pathology.
  
  
  METHODS
  One hundred fifty-two patients underwent robotic hysterectomy for noncancer indications from May 2005 to May 2008. A systematic chart review of consecutive robotic cases was conducted based on preoperative and perioperative characteristics of each patient. Each case was evaluated for its complexity based on preoperative diagnosis, prior pelvic or abdominal surgery, patient's body mass index, and uterine weight.
  
  
  RESULTS
  The overall operative time was 122.9 minutes, estimated blood loss was 79.0 mL, and there were three (2.1%) intraoperative complications, with no perioperative blood transfusions or conversions. There were five (3.5%) patients with postoperative complications, and length of hospital stay was 1.0 days on average. Of the characteristics indicating complexity, only uterine weight greater than 250 g resulted in significantly increased operative times, attributable to increased morcellation time.
  
  
  CONCLUSIONS
  Robotically assisted total hysterectomy for benign indications in patients with complex pathology is feasible, with low morbidity and a short hospital stay. This study suggests that robotic assistance facilitates the use of a minimally invasive approach in high-risk patient populations.
  
  
  METHODS
  III.
authors.affiliation: From the Department of Obstetrics and Gynecology, Division of Gynecology Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: John F
authors.initials: JF
authors.lastname: Boggess
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
authors.forename: Leigh
authors.initials: L
authors.lastname: Cantrell
authors.forename: Aaron
authors.initials: A
authors.lastname: Shafer
authors.forename: Alberto
authors.initials: A
authors.lastname: Mendivil
authors.forename: Emma
authors.initials: E
authors.lastname: Rossi
authors.forename: Rabbie
authors.initials: R
authors.lastname: Hanna
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007902:Length of Stay; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000473:pathology / Q000601:surgery*
references.citation: Bonilla DJ, Mains L, Whitaker R, Crawford B, Finan M, Magnus M. Uterine weight as a predictor of morbidity after a benign abdominal and total laparoscopic hysterectomy. J Reprod Med 2007;52:490–8.
references.citation: Claerhout F, Deprest J. Laparoscopic hysterectomy for benign diseases. Best Pract Res Clin Obstet Gynaecol 2005;19:357–75.
references.citation: O’Hanlan KA, Lopez L, Dibble SL, Garnier AC, Huang GS, Leuchtenberger M. Total laparoscopic hysterectomy: body mass index and outcomes. Obstet Gynecol 2003;102:1384–92.
references.citation: Seracchioli R, Venturoli S, Colombo FM, Bagnoli A, Vianello F, Govoni F, et al. GnRH agonist treatment before total laparoscopic hysterectomy for large uteri. J Am Assoc Gynecol Laparosc 2003;10:316–9.
references.citation: Seracchioli R, Venturoli S, Vianello F, Govoni F, Cantarelli M, Gualerzi B, et al. Total laparoscopic hysterectomy compared with abdominal hysterectomy in the presence of a large uterus. J Am Assoc Gynecol Laparosc 2002;9:333–8.
references.citation: Sizzi O, Paparella P, Bonito C, Paparella R, Rossetti A. Laparoscopic assistance after vaginal hysterectomy and unsuccessful access to the ovaries or failed uterine mobilization: changing trends. JSLS 2004;8:339–46.
references.citation: Wattiez A, Soriano D, Fiaccavento A, Canis M, Botchorishvili R, Pouly J, et al. Total laparoscopic hysterectomy for very enlarged uteri. J Am Assoc Gynecol Laparosc 2002;9:125–30.
references.citation: Beste TM, Nelson KH, Daucher JA. Total laparoscopic hysterectomy utilizing a robotic surgical system. JSLS 2005;9:13–5.
references.citation: Field JB, Benoit MF, Dinh TA, Diaz-Arrastia C. Computer-enhanced robotic surgery in gynecologic oncology. Surg Endosc 2007;21:244–6.
references.citation: Fiorentino RP, Zepeda MA, Goldstein BH, John CR, Rettenmaier MA. Pilot study assessing robotic laparoscopic hysterectomy and patient outcomes. J Minim Invasive Gynecol 2006;13:60–3.
references.citation: Lenihan JP Jr, Kovanda C, Seshadri-Kreaden U. What is the learning curve for robotic assisted gynecologic surgery? J Minim Invasive Gynecol 2008;15:589–94.
references.citation: Marchal F, Rauch P, Vandromme J, Laurent I, Lobontiu A, Ahcel B, et al. Telerobotic-assisted laparoscopic hysterectomy for benign and oncologic pathologies: initial clinical experience with 30 patients. Surg Endosc 2005;19:826–31.
references.citation: Reynolds RK, Advincula AP. Robot-assisted laparoscopic hysterectomy: technique and initial experience. Am J Surg 2006;191:555–60.
references.citation: Reynolds RK, Burke WM, Advincula AP. Preliminary experience with robot-assisted laparoscopic staging of gynecologic malignancies. JSLS 2005;9:149–58.
references.citation: Kho RM, Hilger WS, Hentz JG, Magtibay PM, Magrina JF. Robotic hysterectomy: technique and initial outcomes [published erratum appears in Am J Obstet Gynecol 2007;197:332]. Am J Obstet Gynecol 2007;197:113 e1–4.
references.citation: Payne TN, Dauterive FR. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol 2008;15:286–91.
references.citation: Advincula AP, Reynolds RK. The use of robot-assisted laparoscopic hysterectomy in the patient with a scarred or obliterated anterior cul-de-sac. JSLS 2005;9:287–91.
references.citation: Boggess JF. Gehrig PA, Cantrell L, Shafer A, Ridgway M, Skinner EN, et al. A case-control study of robotic assisted type III radical hysterectomy with pelvic lymph-node dissection compared with open radical hysterectomy. Am J Obstet Gynecol 2008;199:357.e1–7.
references.citation: Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ 2005;330:1478.
references.citation: Leonard F, Chopin N, Borghese B, Fotso A, Foulot H, Coste J, et al. Total laparoscopic hysterectomy: preoperative risk factors for conversion to laparotomy. J Minim Invasive Gynecol 2005;12:312–7.
references.citation: Chapron C, Fernandez B, Dubuisson JB. Total hysterectomy for benign pathologies: direct costs comparison between laparoscopic and abdominal hysterectomy. Eur J Obstet Gynecol Reprod Biol 2000;89:141–7.
references.citation: Gyr T, Ghezzi F, Arslanagic S, Leidi L, Pastorelli G, Franchi M. Minimal invasive laparoscopic hysterectomy with ultrasonic scalpel. Am J Surg 2001;181:516–9.
references.citation: Malzoni M, Perniola G, Perniola F, Imperato F. Optimizing the total laparoscopic hysterectomy procedure for benign uterine pathology. J Am Assoc Gynecol Laparosc 2004;11:211–8.
references.citation: Perino A, Cucinella G, Venezia R, Castelli A, Cittadini E. Total laparoscopic hysterectomy versus total abdominal hysterectomy: an assessment of the learning curve in a prospective randomized study. Hum Reprod 1999;14:2996–9.
references.citation: Wattiez A, Soriano D, Cohen SB, Nervo P, Canis M, Botchorishvili R, et al. The learning curve of total laparoscopic hysterectomy: comparative analysis of 1647 cases. J Am Assoc Gynecol Laparosc 2002;9:339–45.
references.citation: Benassi L, Rossi T, Kaihura CT, Ricci L, Bedocchi L, Galanti B, et al. Abdominal or vaginal hysterectomy for enlarged uteri: a randomized clinical trial. Am J Obstet Gynecol 2002;187:1561–5.
references.citation: Chapron C, Laforest L, Ansquer Y, Fauconnier A, Fernandez B, Breart G, et al. Hysterectomy techniques used for benign pathologies: results of a French multicentre study. Hum Reprod 1999;14:2464–70.
references.citation: David-Montefiore E, Rouzier R, Chapron C, Darai E. Surgical routes and complications of hysterectomy for benign disorders: a prospective observational study in French university hospitals. Hum Reprod 2007;22:260–5.
references.citation: De Meeus JB, Magnin G. Indications of laparoscopic hysterectomy. Eur J Obstet Gynecol Reprod Biol 1997;74:49–52.
references.citation: Falcone T, Paraiso MF, Mascha E. Prospective randomized clinical trial of laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy. Am J Obstet Gynecol 1999;180:955–62.
references.citation: Harmanli OH, Gentzler CK, Byun S, Dandolu MH, Grody T. A comparison of abdominal and vaginal hysterectomy for the large uterus. Int J Gynaecol Obstet 2004;87:19–23.
references.citation: Kafy S, Huang JY, Al-Sunaidi M, Wiener D, Tulandi T. Audit of morbidity and mortality rates of 1792 hysterectomies. J Minim Invasive Gynecol 2006;13:55–9.
references.citation: Leung PL, Tsang SW, Yuen PM. An audit on hysterectomy for benign diseases in public hospitals in Hong Kong. Hong Kong Med J 2007;13:187–93.
references.citation: Makinen J, Johansson J, Tomas C, Tomas E, Heinonen PK, Laatikainen T, et al. Morbidity of 10 110 hysterectomies by type of approach. Hum Reprod 2001;16:1473–8.
references.citation: Marana R, Busacca M, Zupi E, Garcea N, Paparella P, Catalano GF. Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a prospective, randomized, multicenter study. Am J Obstet Gynecol 1999;180:270–5.