title: A Comparison of Outcomes Between Robotic-Assisted, Single-Site Laparoscopy Versus Laparoendoscopic Single Site for Benign Hysterectomy.
abstract: OBJECTIVE
  To compare the perioperative outcomes, including estimated blood loss, conversion to open laparotomy, length of stay, and total operative time of hysterectomies using robotic-assisted, single-site laparoscopy with laparoendoscopic single site (LESS) for benign indications.
  
  
  METHODS
  A retrospective cohort study (Canadian Task Force classification Level II-2.
  
  
  METHODS
  Multicenter (private hospitals).
  
  
  METHODS
  Gynecologic patients who underwent a hysterectomy for benign indications via robotic-assisted, single-site laparoscopy (n = 50) versus LESS (n = 50).
  
  
  METHODS
  Observational study.
  
  
  RESULTS
  Continuous outcomes were analyzed using multiple linear regression, whereas the dichotomous outcome of conversion was analyzed using a multiple log-binomial regression model. Linear and log-binomial regression coefficients were adjusted for the ages of the patients and other clinical factors. A total of 100 consecutive patient records were available for analysis: 50 for robotic-assisted, single-site laparoscopy and 50 for LESS. Univariate analyses revealed that both groups were similar in mean age (robotic, 46.0 years; LESS, 45.4 years; p = .75), but not mean body mass index (robotic, 25.9 kg/m(2); LESS, 28.8 kg/m(2); p = .02). There was no difference in the unadjusted (crude) risk of conversion to a multiport procedure between the robotic and laparoscopic groups (p = .37). There were only 2 major complications (cystotomy and vaginal dehiscence) in the LESS arm and 1 vaginal dehiscence in the robotic-assisted, single-site arm. After adjusting for 7 potential confounders, no relationship was detected between the type of approach (robotic vs laparoscopic) and the outcome of a major complication (exact odds ratio, 0.55; exact p = 1.0). A multivariate linear regression analysis that compared the 2 groups (robotic-assisted single site vs LESS) revealed no differences in estimated blood loss. On average, the robotic-assisted, single-site group had a length of stay that was 8.12 hours shorter than the LESS group (p = .003) after adjusting for patient characteristics. Total operative time was an average of 24.9 min longer in the robotic-assisted, single-site group (p = .002) after adjustment. A plot of total operative time in minutes by chronological case number and procedural approach was analyzed to estimate a learning curve. This plot showed a steeper learning curve with the robotic-assisted, single-site approach.
  
  
  CONCLUSIONS
  This preliminary observational study found that the robotic-assisted, single-site group had a statistically significant decrease in length of hospital stay, but also experienced an increase in total operative time. There were no conversions to open laparotomies.
authors: Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, El Paso, TX. Electronic address: sandra.lopez@ttuhsc.edu.
authors: Sandra
authors: S
authors: Lopez
authors: Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, El Paso, TX.
authors: Zuber D
authors: ZD
authors: Mulla
authors: Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, El Paso, TX.
authors: Loretta
authors: L
authors: Hernandez
authors: Texas Institute for Robotic Surgery, St. David's North Austin Medical Center, Austin, TX.
authors: Devin M
authors: DM
authors: Garza
authors: Texas Institute for Robotic Surgery, St. David's North Austin Medical Center, Austin, TX.
authors: Thomas N
authors: TN
authors: Payne
authors: Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, El Paso, TX.
authors: Richard W
authors: RW
authors: Farnam
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies
keywords: Hysterectomy; Laparoendoscopic single site (LESS); Robotic-assisted single site