title: Total laparoscopic hysterectomy with and without robotic assistance: a prospective controlled study.
abstract: BACKGROUND
  Hysterectomies are very common, and most of them are still performed abdominally. The minimally invasive alternatives are perceived as difficult by gynecologists. Robotic assistance is thought to facilitate laparoscopic surgery. The aim of this study was to compare the surgical outcomes of robotic-assisted and conventional total laparoscopic hysterectomy.
  
  
  METHODS
  Patients, candidate to hysterectomy for benign indications, were allocated to either robotic or conventional laparoscopy in a quasi-randomized fashion. Patients were operated following a standardized surgical protocol. Main outcome measures were total surgical time, conversions to laparotomy, blood loss, hospital stay, and complications.
  
  
  RESULTS
  Fifty-one patients underwent robotic hysterectomy (mean age = 46.59 years) and 54 conventional laparoscopy (mean age = 50.02 years). The groups were homogeneous in body mass index and uterine weight. Robotic-assisted hysterectomies were significantly shorter (154.63 ± 36.57 vs 185.65 ± 42.98 minutes in the control group; P = .0001). Patients in the robotic group also had a significantly smaller reduction in hemoglobin (9.69% ± 8.88% vs 15.29% ± 8.39% in controls; P = .0012) and hematocrit (10.56% ± 8.3% vs 14.89% ± 8.11%; P = .008). No intraoperative conversions to laparotomy were required. Complication rate was low and similar in both groups. All patients were fully recovered at 1-month follow-up outpatient visit.
  
  
  CONCLUSIONS
  Significantly lower operative times and blood loss indicate that robotic assistance can facilitate surgery already during the learning curve period. Nevertheless, proficiency can be reached in conventional laparoscopy through training, and the cost-effectiveness of robotic hysterectomy for benign conditions is yet to be confirmed.
authors.affiliation: "Virgen del Rocio" University Hospital, University of Seville, Seville, Spain.
authors.forename: Maria Angeles
authors.initials: MA
authors.lastname: Martínez-Maestre
authors.affiliation: "Virgen del Rocio" University Hospital, University of Seville, Seville, Spain Uppsala University Hospital, Uppsala, Sweden gambadauro@gmail.com.
authors.forename: Pietro
authors.initials: P
authors.lastname: Gambadauro
authors.affiliation: "Virgen del Rocio" University Hospital, University of Seville, Seville, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: González-Cejudo
authors.affiliation: "Virgen del Rocio" University Hospital, University of Seville, Seville, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Torrejón
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
keywords: blood loss; controlled study; operative time; prospective study; robotic hysterectomy; total laparoscopic hysterectomy