Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan, ROC.
Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2022 Aug 1;85(8):853-858. doi: 10.1097/JCMA.0000000000000760. Epub 2022 Jun 6.
Robotic total hysterectomies have been considered contraindicated for patients with intra-abdominal adherences, but the evidence for this is not strong, and we hypothesized that the procedure can be of benefit even in these cases. In our research, we analyzed how the severity of pelvic adhesions affects robotic total hysterectomy, and by comparing different types of adhesions, we can further identify the outcomes differences in between, which may aid in future surgical decision making.
Prospective cohort study (Canadian Task Force classification II-2). All 410 patients with uterine myoma or adenomyosis undergoing robotic total hysterectomies between 2011 and 2016 using the da Vinci Si system by the same surgeon in Taipei Medical University Hospital were included in the study.
Baseline characteristics, blood loss, docking time, operation time, time to perform uterine artery ligation (UAL), pain score, hospital stay, complication rate, and laparotomy conversion rate were analyzed between benign cases with or without pelvic adhesions undergoing robotic total hysterectomy. Furthermore, in our subgroups analysis, we have divided the patients with adhesion into different groups according to the severity of adhesion. The abdomen and pelvic cavity was divided into nine sections, and the outcomes of different adhesion condition were compared. We found that patients with adhesions had increased docking time and operation time, but other differences between groups were not statistically significant. The results of the adhesion group showed no significant increases in blood loss, intra- and postoperative complications, and length of hospital stay. Only significantly longer surgical time compared with the normal group was noted.
Our results suggest that robotic total hysterectomies with UAL are effective and safe for patients with benign gynecologic conditions, and the surgical method should be considered even for patients with adhesion risks.
机器人全子宫切除术曾被认为不适用于有腹腔内粘连的患者，但这方面的证据并不充分，我们假设即使在这些情况下，该手术也可能有益。在我们的研究中，我们分析了盆腔粘连的严重程度如何影响机器人全子宫切除术，并通过比较不同类型的粘连，我们可以进一步确定它们之间的结果差异，这可能有助于未来的手术决策。
前瞻性队列研究（加拿大任务组分类 II-2）。2011 年至 2016 年间，同一位外科医生在台北医学大学附属医院使用达芬奇 Si 系统对 410 例患有子宫肌瘤或子宫腺肌病的患者进行了机器人全子宫切除术，这些患者均纳入本研究。
对良性病例中有无盆腔粘连的患者进行机器人全子宫切除术，比较其基线特征、出血量、对接时间、手术时间、行子宫动脉结扎术（UAL）时间、疼痛评分、住院时间、并发症发生率和剖腹手术转化率。此外，在我们的亚组分析中，我们根据粘连的严重程度将患者分为不同的组。将腹部和盆腔分为九个区域，比较不同粘连情况的结果。我们发现粘连患者的对接时间和手术时间增加，但组间其他差异无统计学意义。粘连组的出血量、术中及术后并发症和住院时间无显著增加。与正常组相比，只有手术时间显著延长。
我们的结果表明，对于良性妇科疾病患者，行 UAL 的机器人全子宫切除术是有效且安全的，即使对于有粘连风险的患者，也应考虑该手术方法。
