title: Comparison of 2 minimally invasive routes for hysterectomy of large uteri.
abstract: OBJECTIVE
  To compare the perioperative outcomes associated with 2 minimally invasive surgical routes for the hysterectomy of large fibroid uteri.
  
  
  METHODS
  Retrospective review of 84 women undergoing hysterectomy via minilaparotomy (n=54) or robot-assisted laparoscopy (n=30) for uteri weighing at least 500g. Outcome measures included hemorrhage (blood loss of 500mL or more) and postoperative length of stay.
  
  
  RESULTS
  Unadjusted mean blood loss (560.2±507.4mL versus 165.0±257.5mL, P<0.001), rate of hemorrhage (40.7% versus 6.7%, P=0.001, odds ratio 6.1 [95% confidence interval 1.5-24.2]), and rate of blood transfusion (14.8% versus 0%, P=0.03 ) were all higher with minilaparotomy than with robot-assisted surgery, while the median postoperative stay was significantly shorter with robotic surgery (2 [range 1-4] days versus 1 [range 0-7] days, P<0.01). After adjusting for differences in uterine weight using a multivariate linear regression analysis, the mean blood loss and the rate of hemorrhage were no longer significantly different between the 2 groups.
  
  
  CONCLUSIONS
  The minilaparotomy approach may be used to remove very large uteri and does not require specialized and expensive equipment, or advanced endoscopic training. The robotic approach, when feasible, allows for early postoperative discharge.
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan Health Center, Ann Arbor, USA. noam_yossi@yahoo.com
authors.forename: Noam
authors.initials: N
authors.lastname: Smorgick
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Dalton
authors.forename: Kristin E
authors.initials: KE
authors.lastname: Patzkowsky
authors.forename: Mark R
authors.initials: MR
authors.lastname: Hoffman
authors.forename: Arnold P
authors.initials: AP
authors.lastname: Advincula
authors.forename: Sawsan
authors.initials: S
authors.lastname: As-Sanie
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D016014:Linear Models; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D012189:Retrospective Studies; D012371:Robotics; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*