Robotic Hysterectomy: Surgical Approach and Outcomes Among a Large Institutional Cohort

Abstract

Introduction The purpose of this report is to describe a technique for performing a robotic total laparoscopic hysterectomy (rTLH) with clinical outcomes on safety and efficiency. The rationale for our approach is based on a critical evaluation of the literature. Methods Data from all rTLH procedures performed on our gynecologic oncology service between January 2017 and December 2019 were retrospectively reviewed. Using this database, perioperative data including surgical times, intra- and postoperative complications, and length of hospital stays were evaluated. The steps used to perform the procedure were outlined and illustrated. Results 826 cases of rTLH were performed during the study period. 688 of these cases were included for analysis. Malignant diagnoses were found in 218 cases. The median time from skin-to-skin for the entire cohort was 28.43 minutes for benign rTLH +/- BSO (bilateral salpingo oophorectomy) and 30.23 minutes for rTLH/BSO/cancer staging. Surgical complications included vaginal laceration, vaginal bleeding, urinary tract infection, serous fluid leakage from the incision, abdominal wall abscess, pelvic abscess, surgical site infection, serosal tear, enterotomy, rectal injury, acute kidney injury, perforated diverticulitis, and incarcerated bowel through the ventral hernia. The median length of stay was 1 day. The surgical technique is illustrated step by step. Conclusion This paper describes a safe and efficient technique to perform rTLH and shows that surgical times, complication rates, and length-of-stays compare favorably to the literature. A description of the technique clarifies many of the details of this procedure which can be made routine to minimize error and surgeon discrepancies. We encourage readers to use this paper as a guide to modify their techniques for robotically assisted laparoscopic hysterectomy.

Keywords

• robotic hysterectomy
• technique
• outcome