Comparison of Perioperative Outcomes of Total Laparoscopic and Robotically Assisted Hysterectomy for Benign Pathology during Introduction of a Robotic Program
Study Objective. Prospectively compare outcomes of robotically assisted and laparoscopic hysterectomy in the process of implementing a new robotic program. Design. Prospectively comparative observational nonrandomized study. Design Classification. II-1. Setting. Tertiary caregiver university hospital. Patients. Data collected consecutively 24 months, 34 patients underwent laparoscopic hysterectomy, 25 patients underwent robotic hysterectomy, and 11 patients underwent vaginal hysterectomy at our institution. Interventions. Outcomes of robotically assisted, laparoscopic, and vaginal complex hysterectomies performed by a single surgeon for noncancerous indications. Measurements and Main Results. Operative times were minutes for laparoscopic, minutes for robotic, and minutes for vaginal ( ). Estimated blood loss for patients undergoing laparoscopic surgery was ？cc, ？cc for robotic surgery, and ？cc for vaginal surgery ( ). The mean length of stay ranged from 1.8 to 2.3 days for the 3 methods. Association was significant for uterine weight ( ) among surgery methods. Conclusion. Robotically assisted hysterectomy is feasible with low morbidity, a shorter hospital stay, and less blood loss. This suggests that robotic assistance facilitates a minimally invasive approach for patients with larger uterine size even during implementing a new robotic program. 1. Introduction Hysterectomy is the second most commonly performed surgical procedure in the United States after cesarean delivery [1]. The Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project reported 518,828 hysterectomies for benign disease in 2005 [2]. A stable rate of 5.1–5.8 hysterectomies per 1,000 female civilian US residents was reported between 1995 and 1999 [3]. The same recent analysis of Healthcare Cost and Utilization Project data showed that abdominal hysterectomy was performed in 64% of cases, followed by the vaginal route in 22% of cases and the laparoscopic route in 14%. Robotic-assisted hysterectomy is emerging as a new technique for hysterectomy [2]. Improved visualization and dexterity in robotic surgery may offer some advantages over conventional laparoscopy [4, 5], and shorter hospital stays and decreased blood loss may also be advantages over laparotomy [6, 7]. Overall, minimally invasive surgical techniques for performing hysterectomy have been shown to reduce patient morbidity and shorten hospital stays [8, 9]. A robotic system (da Vinci Surgical System, Intuitive Surgical, Inc., Sunnyvale, CA) is designed to address many of the limitations of conventional
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