Clinical experience analysis of robotic hysterectomy in 62 patients with large uteri_West China Medical Journal

Authors：

ZHANG Haiyan ^1,2 , FAN Wensheng ¹ , WANG Juntong ² , ZHANG Boxue ² , ZHAO Yang ² ,  MENG Yuanguang ¹

1. Department of Gynecology and Obstetrics, Chinese PLA General Hospital, Beijing 100853, P. R. China;
2. Department of Gynecology and Obstetrics, Tangshan Workers Hospital, Tangshan, Tianjin 063000, P. R. China;

Corresponding?author：

MENG Yuanguang, Email: meng6512@vip.sina.com

Keywords：

Robotic surgery; Laparoscopy; Hysterectomy; Large uteri; Minimally invasive surgery

DOI：

10.7507/1002-0179.201908140

Video：

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Objective To summarize the data of robotic hysterectomy in patients with large and super-large uterus in single center, and explore the relevant clinical experience and advantages of robotic surgery.Methods The medical records of the patients with large uterus caused by gynecological diseases who underwent robotic hysterectomy in the Chinese PLA General Hospital from January 2016 to December 2018 were retrospectively analyzed. The patients with uterine size from 12 to 16 weeks of gestation were divided into large uterus group and those with uterine volume larger than 16 weeks of gestation were divided into super large uterus group.Results A total of 62 patients were included, including 28 in the large uterus group with the average uterus size of (14.3±2.1) gestational weeks, and 34 in the super large uterus group with the average uterus size of (19.9±2.8) gestational weeks. There was no significant difference in mean age, body mass index, history of abdominal surgery or diagnostic composition between the two groups (P>0.05), except for the size of the uterus (t=8.772, P<0.001). The operation time in the large uterus group was less than that in the super-large uterus group [(75.4±22.6) vs. (91.7±27.8) min; t=2.495, P=0.015]. The incidence of complications after robotic hysterectomy was 14.5% (9/62) in the 62 patients, including 14.3% (4/28) in the large uterus group and 14.7% (5/34) in the super-large uterus group. There was no significant difference in the amount of bleeding, blood transfusion rate, ratio of conversion to open surgery, average hospitalization days or incidence of postoperative complications between the two groups (P>0.05).Conclusions Robotic hysterectomy has the advantages of flexible manipulator, 3-D operative field of vision and stability of manipulation. In addition, increased uterine volume does not lead to increased surgical trauma, nor apparently affect the prognosis.

Citation： ZHANG Haiyan, FAN Wensheng, WANG Juntong, ZHANG Boxue, ZHAO Yang, MENG Yuanguang. Clinical experience analysis of robotic hysterectomy in 62 patients with large uteri. West China Medical Journal, 2020, 35(2): 187-191. doi: 10.7507/1002-0179.201908140 Copy

1.	Gupta N, Mohling S, Mckendrick R, et al. Perioperative outcomes of robotic hysterectomy with mini-laparotomy versus open hysterectomy for uterus weighing more than 250 g. J Robot Surg, 2018, 12(4): 641-645.
2.	陳必良. 達芬奇機器人在婦科手術中的實踐. 中華腔鏡外科雜志(電子版), 2017, 10(5): 288-289.
3.	Ito TE, Vargas MV, Moawad GN, et al. Minimally invasive hysterectomy for uteri greater than one kilogram. JSLS, 2017, 21(1): pii: e2016.00098.
4.	牛高麗, 趙華. 腹腔鏡大子宮切除術與開腹手術的對比研究. 現代醫藥衛生, 2019, 35(5): 641-643.
5.	Park DA, Lee DH, Kim SW, et al. Comparative safety and effectiveness of robot-assisted laparoscopic hysterectomy versus conventional laparoscopy and laparotomy for endometrial cancer: a systematic review and meta-analysis. Eur J Surg Oncol, 2016, 42(9): 1303-1314.
6.	Silasi DA, Gallo T, Silasi M, et al. Robotic versus abdominal hysterectomy for very large uteri. JSLS, 2013, 17(3): 400-406.
7.	Sinha R, Bana R, Sanjay M. Comparison of robotic and laparoscopic hysterectomy for the large uterus. JSLS, 2019, 23(1): pii: e2018.00068.
8.	常蕊, 王楠, 高燕云. LAVH 巨大子宮切除聯合 GnRH-a 治療的對比研究. 中國煤炭工業醫學雜志, 2017, 20(4): 417-420.
9.	丁曉萍, 侯慶香, 劉蕊, 等. 機器人手術系統輔助婦科手術 60 例報告. 腹腔鏡外科雜志, 2012, 17(10): 784-786.
10.	Lawrie TA, Liu H, Lu D, et al. Robot-assisted surgery in gynaecology. Cochrane Database Syst Rev, 2019: CD011422.
11.	Payne TN, Dauterive FR, Pitter MC, et al. Robotically assisted hysterectomy in patients with large uteri: outcomes in five community practices. Obstet Gynecol, 2010, 115(3): 535-542.
12.	顧成磊, 孟元光. 機器人手術在卵巢癌治療中的應用現狀. 中國微創外科雜志, 2016, 16(11): 1038-1040.
13.	韓亮亮, 閆沛靜, 王子政, 等. 機器人與常規腹腔鏡手術治療宮頸癌的療效比較. 腹腔鏡外科雜志, 2019, 24(5): 371-376.
14.	Chiu LH, Chen CH, Tu PC, et al. Comparison of robotic surgery and laparoscopy to perform total hysterectomy with pelvic adhesions or large uterus. J Minim Access Surg, 2015, 11(1): 87-93.
15.	龔靜, 王楠, 王敏, 等. 機器人手術治療子宮內膜癌合并肥胖. 中國微創外科雜志, 2016, 16(8): 685-688.
16.	李小毛, 王佳. 機器人手術在子宮內膜癌分期手術中安全性與有效性的薈萃分析. 中華婦產科雜志, 2017, 52(3): 175-183.

1. Gupta N, Mohling S, Mckendrick R, et al. Perioperative outcomes of robotic hysterectomy with mini-laparotomy versus open hysterectomy for uterus weighing more than 250 g. J Robot Surg, 2018, 12(4): 641-645.
2. 陳必良. 達芬奇機器人在婦科手術中的實踐. 中華腔鏡外科雜志(電子版), 2017, 10(5): 288-289.
3. Ito TE, Vargas MV, Moawad GN, et al. Minimally invasive hysterectomy for uteri greater than one kilogram. JSLS, 2017, 21(1): pii: e2016.00098.
4. 牛高麗, 趙華. 腹腔鏡大子宮切除術與開腹手術的對比研究. 現代醫藥衛生, 2019, 35(5): 641-643.
5. Park DA, Lee DH, Kim SW, et al. Comparative safety and effectiveness of robot-assisted laparoscopic hysterectomy versus conventional laparoscopy and laparotomy for endometrial cancer: a systematic review and meta-analysis. Eur J Surg Oncol, 2016, 42(9): 1303-1314.
6. Silasi DA, Gallo T, Silasi M, et al. Robotic versus abdominal hysterectomy for very large uteri. JSLS, 2013, 17(3): 400-406.
7. Sinha R, Bana R, Sanjay M. Comparison of robotic and laparoscopic hysterectomy for the large uterus. JSLS, 2019, 23(1): pii: e2018.00068.
8. 常蕊, 王楠, 高燕云. LAVH 巨大子宮切除聯合 GnRH-a 治療的對比研究. 中國煤炭工業醫學雜志, 2017, 20(4): 417-420.
9. 丁曉萍, 侯慶香, 劉蕊, 等. 機器人手術系統輔助婦科手術 60 例報告. 腹腔鏡外科雜志, 2012, 17(10): 784-786.
10. Lawrie TA, Liu H, Lu D, et al. Robot-assisted surgery in gynaecology. Cochrane Database Syst Rev, 2019: CD011422.
11. Payne TN, Dauterive FR, Pitter MC, et al. Robotically assisted hysterectomy in patients with large uteri: outcomes in five community practices. Obstet Gynecol, 2010, 115(3): 535-542.
12. 顧成磊, 孟元光. 機器人手術在卵巢癌治療中的應用現狀. 中國微創外科雜志, 2016, 16(11): 1038-1040.
13. 韓亮亮, 閆沛靜, 王子政, 等. 機器人與常規腹腔鏡手術治療宮頸癌的療效比較. 腹腔鏡外科雜志, 2019, 24(5): 371-376.
14. Chiu LH, Chen CH, Tu PC, et al. Comparison of robotic surgery and laparoscopy to perform total hysterectomy with pelvic adhesions or large uterus. J Minim Access Surg, 2015, 11(1): 87-93.
15. 龔靜, 王楠, 王敏, 等. 機器人手術治療子宮內膜癌合并肥胖. 中國微創外科雜志, 2016, 16(8): 685-688.
16. 李小毛, 王佳. 機器人手術在子宮內膜癌分期手術中安全性與有效性的薈萃分析. 中華婦產科雜志, 2017, 52(3): 175-183.

West China Medical Journal

Clinical experience analysis of robotic hysterectomy in 62 patients with large uteri

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