Perioperative outcomes of three-port robotically assisted hysterectomy: a continuous series of 53 cases

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This study evaluated the feasibility and safety of 3-port robotically assisted hysterectomy in 53 women, finding no perioperative complications with a median 4-day hospital stay.

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This study evaluated feasibility and perioperative safety of three-port robotically assisted laparoscopic hysterectomy (RALH) in a consecutive series of 53 women at a university hospital from November 2010 to June 2013. Indications included myoma (58.5%), adenomyosis (18.9%), cervical dysplasia, neoplasia, and recurrent polyps or postmenopausal bleeding, with most procedures performed as total RALH (94.3%); median operative time was 169 minutes and mean estimated blood loss was 72.3 ml, with no perioperative complications, transfusions, or conversions to laparotomy. Two postoperative events were described: one vaginal vault hematoma requiring reoperation and one readmission for vaginal vault dehiscence after premature intercourse that did not require reoperation. Limitations include the small, single-center continuous series design without a comparator group. Relevance to endometriosis: adenomyosis is included as an indication (18.9% of cases), though the paper’s main focus is perioperative outcomes of three-port robotic hysterectomy.

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Abstract

This study evaluated the feasibility and safety of 3-port robotically assisted laparoscopic hysterectomy (RALH), using a consecutive series of women who underwent 3-port RALH in a university hospital. From November 2010 until June 2013 we operated on 53 women, whose mean age was 48.4 ± 7.7 years (range 35-68 years), and mean body mass index was 27.1 ± 5.1 kg/m(2) (range 19.5-42.9 kg/m(2)). The indications for hysterectomy were myoma in 31 (58.5 %), adenomyosis in 10 (18.9 %), cervical dysplasia in 4 (7.5 %), neoplasia in 4 (7.5 %), and recurrent polyps or postmenopausal bleeding in the remaining 4 women (7.5 %). We performed total RALH in 50 cases (94.3 %) and subtotal in the others. The median duration of total intervention was 169 min (interquartile range 147.5-206.5 min). The mean weight of the uterus was 209.8 ± 166.6 g (range 36-790 g) and mean estimated blood loss was 72.3 ± 75.9 ml (range 0-300 ml). There were no perioperative complications, in particular no blood transfusions nor conversions to laparotomy. The median hospital stay was 4 days (interquartile range 3-4 days). One patient was reoperated 1 month later for vaginal vault hematoma and another was readmitted 3 weeks post-operatively due to vaginal vault dehiscence after premature intercourse, but did not require reoperation. Three-port RALH is feasible and safe for simple hysterectomy. We believe this experience using minimum ports to be useful to prepare for robotically assisted single-port hysterectomy.
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Abstract

This study evaluated the feasibility and safety of 3-port robotically assisted laparoscopic hysterectomy (RALH), using a consecutive series of women who underwent 3-port RALH in a university hospital. From November 2010 until June 2013 we operated on 53 women, whose mean age was 48.4 ± 7.7 years (range 35–68 years), and mean body mass index was 27.1 ± 5.1 kg/m2 (range 19.5–42.9 kg/m2). The indications for hysterectomy were myoma in 31 (58.5 %), adenomyosis in 10 (18.9 %), cervical dysplasia in 4 (7.5 %), neoplasia in 4 (7.5 %), and recurrent polyps or postmenopausal bleeding in the remaining 4 women (7.5 %). We performed total RALH in 50 cases (94.3 %) and subtotal in the others. The median duration of total intervention was 169 min (interquartile range 147.5–206.5 min). The mean weight of the uterus was 209.8 ± 166.6 g (range 36–790 g) and mean estimated blood loss was 72.3 ± 75.9 ml (range 0–300 ml). There were no perioperative complications, in particular no blood transfusions nor conversions to laparotomy. The median hospital stay was 4 days (interquartile range 3–4 days). One patient was reoperated 1 month later for vaginal vault hematoma and another was readmitted 3 weeks post-operatively due to vaginal vault dehiscence after premature intercourse, but did not require reoperation. Three-port RALH is feasible and safe for simple hysterectomy. We believe this experience using minimum ports to be useful to prepare for robotically assisted single-port hysterectomy. Similar content being viewed by others

References

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