Introduction: Robotic hysterectomy using standard diathermy instruments has been reported in benign gynaecology over the past decade, however, perioperative outcomes, such as pain scores, for this procedure between small and large uteri using a sealing device are not well reported in large series. Hence, we aimed to investigate, in a large retrospective cohort study of 156 consecutive patients, the rate of complications between small and large uteri in robotic benign hysterectomy using a sealing device which enables simultaneous dissection, sealing, and cutting of tissues. As secondary outcomes, we investigated the differences in pain scores, operative times, and lengths of hospitalisation between the two groups. To differentiate between small and large uteri, the commonly used threshold of 250 grams was used. Eighty-two cases were included in the small uteri group and 70 in the large uteri group. For four cases, no weight was reported.
Results: There was a statistically significant longer operative time for the large uteri group-105 minutes versus 85 minutes for the small uteri group. This difference was due to the longer duration of vaginal removal. The postoperative pain scores were comparable between small and large uteri. The overall complication rate in our series was very low, with 3.2% intraoperative complications and 4.4% postoperative complications. There was no significant difference in peri- and postoperative complication rate, as well as length of hospitalisation between the small and large uteri group.
Conclusion: In this retrospective cohort study of robotic hysterectomy using a sealing device, there was no difference in perioperative outcome between small and large uteri, but we could demonstrate shorter operative times compared to previous reports on large uteri, most likely due to the versatility of the application of the EndoWrist® Vessel Sealer (Intuitive Surgical, Inc., Sunnyvale, California). Given the known difference in complication rate and length of hospitalization between small and large uteri in laparoscopic hysterectomy, this study shows that robotic hysterectomy is a recommended procedure for benign indications in small, and especially large uteri.