title: Novel port placement and 5-mm instrumentation for robotic-assisted hysterectomy.
abstract: OBJECTIVE
  The value of robotic surgery for gynecologic procedures has been critically evaluated over the past few years. Its drawbacks have been noted as larger port size, location of port placement, limited instrumentation, and cost. In this study, we describe a novel technique for robotic-assisted laparoscopic hysterectomy (RALH) with 3 important improvements: (1) more aesthetic triangular laparoscopic port configuration, (2) use of 5-mm robotic cannulas and instruments, and (3) improved access around the robotic arms for the bedside assistant with the use of pediatric-length laparoscopic instruments.
  
  
  METHODS
  We reviewed a series of 44 women who underwent a novel RALH technique and concomitant procedures for benign hysterectomy between January 2008 and September 2011.
  
  
  RESULTS
  The novel RALH technique and concomitant procedures were completed in all of the cases without conversion to larger ports, laparotomy, or video-assisted laparoscopy. Mean age was 49.9 years (SD 8.8, range 33-70), mean body mass index was 26.1 (SD 5.1, range 18.9-40.3), mean uterine weight was 168.2 g (SD 212.7, range 60-1405), mean estimated blood loss was 69.7 mL (SD 146.9, range 20-1000), and median length of stay was <1 day (SD 0.6, range 0-2.5). There were no major and 3 minor peri- and postoperative complications, including 2 urinary tract infections and 1 case of intravenous site thrombophlebitis. Mean follow-up time was 40.0 months (SD 13.6, range 15-59).
  
  
  CONCLUSIONS
  Use of the triangular gynecology laparoscopic port placement and 5-mm robotic instruments for RALH is safe and feasible and does not impede the surgeon's ability to perform the procedures or affect patient outcomes.
authors: Emory University School of Medicine, Atlanta Center for Reproductive Medicine, Minimally Invasive and Robotic Surgery, 5555 Peachtree Dunwoody Road, Suite 276, Atlanta, GA 30342, USA. ceana@nezhat.com.
authors: Ceana H
authors: CH
authors: Nezhat
authors: Department of Obstetrics and Gynecology, Northshore-Long Island Jewish Health Systems, Manhasset, New York, USA.
authors: Adi
authors: A
authors: Katz
authors: Atlanta Center for Reproductive Medicine, Minimally Invasive and Robotic Surgery, Atlanta, Georgia, USA.
authors: Erica C
authors: EC
authors: Dun
authors: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors: Kimberly A
authors: KA
authors: Kho
authors: Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA.
authors: Friedrich A
authors: FA
authors: Wieser
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures