title: Comparison of robotic surgery and laparoscopy to perform total hysterectomy with pelvic adhesions or large uterus.
abstract: BACKGROUND
  Currently, benefits of robotic surgery in patients with benign gynecological conditions remain unclear. In this study, we compared the surgical outcome of robotic and laparoscopic total hysterectomies and evaluated the feasibility of robotic surgery in cases with pelvic adhesions or large uterus.
  
  
  METHODS
  A total of 216 patients receiving total hysterectomy via robotic or laparoscopic approach were included in this study. Of all 216 patients, 88 underwent robotic total hysterectomy and 128 underwent laparoscopic total hysterectomy. All cases were grouped by surgical type, adhesion score, and uterine weight to evaluate the interaction or individual effect to the surgical outcomes. The perioperative parameters, including operation time, blood loss, postoperative pain score, time to full diet resumption, length of hospital stay, conversion rate, and surgery-related complications were compared between the groups.
  
  
  RESULTS
  Operation time and blood loss were affected by both surgical type and adhesion score. For cases with severe adhesions (adhesion score greater than 4), robotic surgery was associated with a shortened operation time (113.9 ± 38.4 min versus 164.3 ± 81.4 min, P = 0.007) and reduced blood loss (187.5 ± 148.7 mL versus 385.7 ± 482.6, P=0.044) compared with laparoscopy. Moreover, robotic group showed a lower postoperative pain score than laparoscopic group, as the effect was found to be independent of adhesion score or uterine weight. The grade-II complication rate was also found to be lower in the robotic group.
  
  
  CONCLUSIONS
  Comparing to laparoscopic approach, robotic surgery is a feasible and potential alternative for performing total hysterectomy with severe adhesions.
authors.affiliation: Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Li-Hsuan
authors.initials: LH
authors.lastname: Chiu
authors.affiliation: Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan ; School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Ching-Hui
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Pei-Chia
authors.initials: PC
authors.lastname: Tu
authors.affiliation: Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan ; School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Ching-Wen
authors.initials: CW
authors.lastname: Chang
authors.affiliation: Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan ; School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Yuan-Kuei
authors.initials: YK
authors.lastname: Yen
authors.affiliation: Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan ; School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Wei-Min
authors.initials: WM
authors.lastname: Liu
keywords: Pelvic adhesions; robotic surgery; total hysterectomy