Silasi Dan-Arin, Gallo Taryn, Silasi Michelle, Menderes Gulden, Azodi Masoud
Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Yale University School of Medicine, 333 Cedar St, FMB 328, New Haven, CT 06520, USA.
JSLS. 2013 Jul-Sep;17(3):400-6. doi: 10.4293/108680813X13693422521755.
We sought to examine the outcomes of patients with myomatous uteri weighing >1000 g who underwent hysterectomy by one of two modalities, either with a robotic system or by laparotomy.
All patients who underwent robotic hysterectomy for uteri weighing >1000 g at our institution between May 2007 and January 2011 were identified, and a retrospective chart review was performed. These patients were matched to a laparotomy control group by body mass index and uterine weight, and the postoperative outcomes in both groups were analyzed and compared.
Sixty patients with uteri weighing >1000 g underwent hysterectomy, 30 with the robotic system and 30 by laparotomy. The median body mass index was 31.8 kg/m(2) (range, 18.5-56.3 kg/m(2)) and the median uterine weight was 1259 g (range, >1000 -3543 g) in the robotic group versus 30.2 kg/m(2) (range, 18 - 48 kg/m(2)) and 1509 g (range, 1000 -3570 g), respectively, in the laparotomy group (P = .31). The median operating time was 255 minutes (range, 180 -372 minutes) in the robotic group versus 150 minutes (range, 100 -285 minutes) in the laparotomy group (P < .001). There were no conversions to laparotomy. In both groups the operative time was not increased with increasing specimen weight. The median blood loss was 150 mL in the robotic group versus 425 mL in the laparotomy group. Of 30 patients in the robotic group, 23 (76.6%) were discharged from the hospital on postoperative day 1. The median hospital stay for the robotic group was 1 day, and for the laparotomy group, it was 2.5 days (P < .01).
Robotic surgeries for very large myomatous uteri are feasible and have minimal morbidity even in morbidly obese patients. The robotic surgery requires a longer operative time but results in a shorter hospital stay and decreased intraoperative blood loss.
我们试图研究子宫重量超过1000克的子宫肌瘤患者通过两种方式之一进行子宫切除术后的结果，这两种方式分别是使用机器人系统或开腹手术。
确定了2007年5月至2011年1月期间在我们机构接受机器人辅助子宫切除术且子宫重量超过1000克的所有患者，并进行了回顾性病历审查。通过体重指数和子宫重量将这些患者与开腹手术对照组进行匹配，并对两组的术后结果进行分析和比较。
60例子宫重量超过1000克的患者接受了子宫切除术，30例使用机器人系统，30例进行开腹手术。机器人组的中位体重指数为31.8kg/m²（范围为18.5 - 56.3kg/m²），中位子宫重量为1259克（范围为>1000 - 3543克）；开腹手术组的中位体重指数分别为30.2kg/m²（范围为18 - 48kg/m²），中位子宫重量为1509克（范围为1000 - 3570克）（P = 0.31）。机器人组的中位手术时间为255分钟（范围为180 - 372分钟），开腹手术组为150分钟（范围为100 - 285分钟）（P < 0.001）。没有转为开腹手术的情况。两组的手术时间均未随标本重量增加而延长。机器人组的中位失血量为150毫升，开腹手术组为425毫升。机器人组的30例患者中，23例（76.6%）在术后第1天出院。机器人组的中位住院时间为1天，开腹手术组为2.5天（P < 0.01）。
对于非常大的子宫肌瘤进行机器人手术是可行的，即使在病态肥胖患者中发病率也很低。机器人手术需要更长的手术时间，但住院时间更短，术中失血量减少。
