Sinha Rooma, Bana Rupa, Sanjay Madhumathi
Department of Gynecology, Apollo Hospitals, Jubilee Hills, Hyderabad, India.
JSLS. 2019 Jan-Mar;23(1). doi: 10.4293/JSLS.2018.00068.
We compared the outcome of robotic hysterectomy (RH) with laparoscopic hysterectomy (LH) for large uteri (≥16 weeks).
This was a retrospective review over 5 years of 165 women (RH, 46; LH, 119). Demographic data, conversion, hemoglobin drop, indication, operating time, postoperative stay, and intra-operative strategies (adhesiolysis, myomectomy) were recorded.
Mean age was 45.7 ± 6.4 years and 44.5 ± 5.4 years (no diff) and body mass index was 30.2 ± 6.3 kg/m and 27.8 ± 4.8 kg/m ( = .009) in the RH and LH groups. There was no difference in percentage of women with previous laparotomy (RH, 15.2% vs LH, 13.4%) and mean number of lower-segment caesarean section (RH, 1.0 vs LH, 0.8). Mean size of uterus was similar (RH, 20.0 weeks vs LH, 17.4 weeks). The mean number of ports was higher in the RH group (RH, 4.2 vs LH, 3.4; < .001) as was needed for adhesiolysis (RH, 71.7% vs LH, 35.3%; < .001). Difficult bladder dissection was more in the RH group (56.5% vs 26.1%; < .001). Vaginal morcellation was similar in both groups (RH, 89.1%; LH, 83.2%). RH took longer operating time (131.0 vs 110.6 minutes; = .006). RH had less drop in Hb (1.0 vs 1.8 g/dL; < .001) and remained the same after multiple regression analysis. Postoperative stay was similar in both groups (1.4 days). Requirement of intravenous analgesia was significantly lower in the RH group (12.5 vs 30.9 hours; < .001). Open conversion rate was 4.3% (RH) and 10.9% (LH) but not significant.
A higher body mass index, more adhesiolysis, and difficult bladder dissection imply a more challenging nature of women who underwent RH. Despite this, RH was shown to be feasible and safe with a lower blood loss.
我们比较了机器人辅助子宫切除术（RH）与腹腔镜子宫切除术（LH）治疗大子宫（≥16周）的效果。
这是一项对165名女性进行的5年回顾性研究（RH组46例；LH组119例）。记录了人口统计学数据、中转情况、血红蛋白下降情况、手术指征、手术时间、术后住院时间及术中策略（粘连松解、肌瘤切除术）。
RH组和LH组的平均年龄分别为45.7±6.4岁和44.5±5.4岁（无差异），体重指数分别为30.2±6.3kg/m²和27.8±4.8kg/m²（P = 0.009）。既往有剖腹手术史的女性比例（RH组15.2% vs LH组13.4%）及下段剖宫产平均次数（RH组1.0 vs LH组0.8）无差异。子宫平均大小相似（RH组20.0周 vs LH组17.4周）。RH组平均端口数量更多（RH组4.2个 vs LH组3.4个；P < 0.001），粘连松解所需端口数量也更多（RH组71.7% vs LH组35.3%；P < 0.001）。RH组膀胱分离困难的情况更多（56.5% vs 26.1%；P < 0.001）。两组阴道碎切术情况相似（RH组89.1%；LH组83.2%）。RH手术时间更长（131.0分钟 vs 110.6分钟；P = 0.006）。RH组血红蛋白下降更少（1.0 g/dL vs 1.8 g/dL；P < 0.001），多元回归分析后结果不变。两组术后住院时间相似（1.4天）。RH组静脉镇痛需求显著更低（12.5小时 vs 30.9小时；P < 0.001）。开放手术中转率RH组为4.3%，LH组为10.9%，但差异无统计学意义。
较高的体重指数、更多的粘连松解及膀胱分离困难表明接受RH手术的女性情况更具挑战性。尽管如此，RH显示出可行且安全，失血更少。
