title: Robotic versus abdominal hysterectomy for very large uteri.
abstract: OBJECTIVE
  We sought to examine the outcomes of patients with myomatous uteri weighing >1000 g who underwent hysterectomy by one of two modalities, either with a robotic system or by laparotomy.
  
  
  METHODS
  All patients who underwent robotic hysterectomy for uteri weighing >1000 g at our institution between May 2007 and January 2011 were identified, and a retrospective chart review was performed. These patients were matched to a laparotomy control group by body mass index and uterine weight, and the postoperative outcomes in both groups were analyzed and compared.
  
  
  RESULTS
  Sixty patients with uteri weighing >1000 g underwent hysterectomy, 30 with the robotic system and 30 by laparotomy. The median body mass index was 31.8 kg/m(2) (range, 18.5-56.3 kg/m(2)) and the median uterine weight was 1259 g (range, >1000 -3543 g) in the robotic group versus 30.2 kg/m(2) (range, 18 - 48 kg/m(2)) and 1509 g (range, 1000 -3570 g), respectively, in the laparotomy group (P = .31). The median operating time was 255 minutes (range, 180 -372 minutes) in the robotic group versus 150 minutes (range, 100 -285 minutes) in the laparotomy group (P < .001). There were no conversions to laparotomy. In both groups the operative time was not increased with increasing specimen weight. The median blood loss was 150 mL in the robotic group versus 425 mL in the laparotomy group. Of 30 patients in the robotic group, 23 (76.6%) were discharged from the hospital on postoperative day 1. The median hospital stay for the robotic group was 1 day, and for the laparotomy group, it was 2.5 days (P < .01).
  
  
  CONCLUSIONS
  Robotic surgeries for very large myomatous uteri are feasible and have minimal morbidity even in morbidly obese patients. The robotic surgery requires a longer operative time but results in a shorter hospital stay and decreased intraoperative blood loss.
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Yale University School of Medicine, 333 Cedar St, FMB 328, New Haven, CT 06520, USA. Dan-Arin.Silasi@yale.edu.
authors.forename: Dan-Arin
authors.initials: DA
authors.lastname: Silasi
authors.forename: Taryn
authors.initials: T
authors.lastname: Gallo
authors.forename: Michelle
authors.initials: M
authors.lastname: Silasi
authors.forename: Gulden
authors.initials: G
authors.lastname: Menderes
authors.forename: Masoud
authors.initials: M
authors.lastname: Azodi
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications; D061646:Operative Time; D009929:Organ Size; D011183:Postoperative Complications; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D063186:Uterine Myomectomy / Q000379:methods*; D014599:Uterus / Q000473:pathology* / Q000601:surgery*
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