Surgical outcomes of robotic hysterectomy for large uterus weighing more than 1000 g: a retrospective study from a high-volume center

Abstract

Performing robotic hysterectomy (RH) on large uteri is a significant challenge. This study aims to investigate the impact of various risk factors on surgical outcomes and to identify the most effective surgical approach for performing RH on uteri weighing over 1000 g in benign conditions. Uterine types were categorized as Type A and Type B based on the site of prominent lesions. Adhesions were re-assessed using the modified American Fertility Society score. During the study period, a total of 86 patients were included in the analysis. The average age of the population was 47.1 ± 4.5 years, and the median uterine weight was 1274 (ranges 1010-2250)g. Thirty-three (38.4%) cases were divided into Type A, while 53 (61.6%) cases were divided into Type B. The median duration of the operation was 160 (75-390) minutes, correlating significantly with increasing uterine weight (P = 0.005) and adhesion severity (P = 0.028). The median estimated blood loss was 150 (20-2000)ml, with significant differences observed between the groups based on uterine type (P = 0.049). A small percentage of patients (4.7%) required conversion to open surgery, which is also correlated significantly with uterine type (P = 0.019). Notably, uterine lesion type was identified as the sole independent predictor for total surgical complications (OR = 3.370, 95% CI 1.196-9.499; P = 0.022). In conclusion, RH is a viable and safe option for treating large uteri weighing more than 1000 g. Surgeons may consider the uterine type when determining the most suitable surgical method, as this can impact the conversion rate and overall surgical complications.