title: Does size matter? The effect of uterine weight on robot-assisted total laparoscopic hysterectomy outcomes.
abstract: The objective of this study was to determine whether uterine weight affects the surgical outcomes of robot-assisted total laparoscopic hysterectomy (RH) procedures. The design of this study is retrospective cohort study. The classification of the study design is level II-2 evidence. The study setting is the Henry Ford Health System's Community Teaching Hospitals. One-hundred and thirty-five patients underwent RH for benign indications at one of two hospitals between January1, 2008, and June 1, 2010. Interventions were scheduled RH without concomitant uro-gynecologic procedures as the intention to treat. Patient demographics, age, height, weight, estimated blood loss (EBL), procedure duration, uterine weight, pathology, length of hospital stay (LOS), and any complications were obtained from a detailed review of electronic medical records. Uterine weight ranged from 47 to 1,290 g (<250 g, n = 87; 250-500 g, n = 28; >500 g, n = 18). Overall, uterine weight was highly correlated with procedure duration (r = .53, P < .001.). Median procedure duration increased from 150 min for the <250 g group, to 205 min for the 250-500 g group, and to 295 min for the >500 g group. Uterine weight was also moderately correlated with EBL (r = .30, P = .0005). Median EBL increased from 50 ml for uteri <250 g to 87.5 ml for the 250-500 g group, and 100 ml for the >500 g group. This correlation did not persist in the assessment of decrease in peri-operative hemoglobin (r = .09, P = .30). Ninety-one women had a LOS of 1 day (67.4%), 31 women had a LOS of 2 days (23%), and 13 women had a LOS of greater than 2 days (9.6%). Uterine weight was not correlated with LOS (r = .14, P = .10) and was not associated with increased major or minor complications (WRS P = .79) re-admission (WRS P = .35), or blood transfusion (n = 3). RH can be performed on patients with large uteri exceeding 500 g without associated adverse outcomes. Although procedure duration is increased, there is no significant effect on EBL and no increase in the occurrence of complications or length of stay.
authors.affiliation: Division of Minimally Invasive Gynecology and Robotic Surgery, Department of Obstetrics, Gynecology, and Women's Health, Henry Ford Health System, Detroit, MI, USA. morady1@hfhs.org.
authors.forename: Mona E
authors.initials: ME
authors.lastname: Orady
authors.affiliation: Division of Minimally Invasive Gynecology and Robotic Surgery, Department of Obstetrics, Gynecology, and Women's Health, Henry Ford Health System, Detroit, MI, USA.
authors.forename: A
authors.initials: A
authors.lastname: Karim Nawfal
authors.affiliation: Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Ganesa
authors.initials: G
authors.lastname: Wegienka
keywords: DaVinci hysterectomy; Large uterus; Robotic hysterectomy; Uterine fibroids; Uterine weight