From Ochsner Health Center, Baton Rouge, Louisiana; Newark Beth Israel Medical Center, New Jersey; Hackensack Medical Center, New Jersey; Spartanburg Regional Medical Center, South Carolina; Mount Carmel Medical Center, Columbus, Ohio; Mercy Medical Center, Oklahoma City, Oklahoma; and Stanford University School of Medicine, California.
Obstet Gynecol. 2010 Mar;115(3):535-542. doi: 10.1097/AOG.0b013e3181cf45ad.
To examine outcomes of robotically assisted laparoscopic hysterectomy in patients with benign conditions involving high uterine weight and complex pathology.
A multicenter study was undertaken in five community practice settings across the United States. All patients who had minimally invasive laparoscopic hysterectomy with robotic assistance March 2006 through July 2009 and uterine weights of at least 250 g were included. Retrospective chart review identified outcomes including skin-to-skin operative time, conversion to an exploratory laparotomy, blood loss, complications, and hospital duration of stay. The effect of uterine weight on skin-to-skin time and blood loss also was examined.
Data were analyzed for 256 patients with uteri weighing 250 to 3,020 g (median 453 g). Most patients were obese or had a history of pelvic or abdominal surgery. Median operative time was 145 minutes. Duration of surgery in patients with uteri 500 g or greater was significantly longer than in patients with uteri less than 500 g (167 compared with 126 minutes, P<.001). Median estimated blood loss also was greater in women with uteri weighing 500 g or more (100 compared with 50 mL, P<.001). Multivariable linear regression analysis confirmed the independent effect of uterine weight on operative time and blood loss. Median duration of hospital stay was 1 day. The conversion rate was 1.6%, the minor complication rate was 1.6%, and major complications occurred in 2.0% of patients.
Women with large uteri may successfully undergo robotically assisted hysterectomy with low morbidity, low blood loss, and minimal risk of conversion to laparotomy. Results were reproducible among general gynecologists from geographically diverse community settings.
研究机器人辅助腹腔镜子宫切除术治疗涉及高子宫重量和复杂病理的良性疾病患者的结局。
在美国五个社区实践地点进行了一项多中心研究。所有于 2006 年 3 月至 2009 年 7 月接受微创腹腔镜子宫切除术且有机器人辅助、子宫重量至少为 250 克的患者均被纳入研究。回顾性病历分析确定了包括皮肤对皮肤手术时间、转为剖腹探查术、出血量、并发症和住院时间在内的结局。还检查了子宫重量对皮肤对皮肤时间和出血量的影响。
对 256 名子宫重量为 250 至 3020 克（中位数 453 克）的患者进行了数据分析。大多数患者肥胖或有盆腔或腹部手术史。中位手术时间为 145 分钟。子宫重量为 500 克或以上的患者手术时间明显长于子宫重量小于 500 克的患者（167 分钟比 126 分钟，P<.001）。子宫重量为 500 克或以上的患者估计出血量中位数也更大（100 毫升比 50 毫升，P<.001）。多变量线性回归分析证实了子宫重量对手术时间和出血量的独立影响。中位住院时间为 1 天。转化率为 1.6%，轻微并发症发生率为 1.6%，主要并发症发生率为 2.0%。
子宫较大的女性可以成功接受机器人辅助子宫切除术，具有较低的发病率、较低的出血量和较低的剖腹手术风险。来自地理位置不同的社区实践的普通妇科医生的结果是可重复的。
