• DaVinci
• enlarged uterus
• fibroid
• fibromatosis
• leiomyoma
• robot-assisted surgery

Hysterectomy is one of the most frequently performed major gynecological procedure, often for definitive treatment of symptomatic uterine fibromatosis. In case of very enlarged uteri, vaginal or laparoscopic hysterectomy can result particularly challenging and unsafe. While many surgeons will perform a laparotomic hysterectomy in this scenario, we hypothesized that robotic hysterectomy could be applicable in this patients’ subset with similar results compared to patients with smaller uteri who undergo the same procedure.
This single center cohort study on 138 consecutive patients aims to verify this hypothesis. We compared intraoperative and postoperative outcomes of robotic hysterectomies in patients with uterine weight < 613 g (n = 69) and in patients with uterine weight ≥ 613 g (n = 69). Multivariate analysis was conducted to identify independent predictors of total operative time, estimated blood loss and length of hospital stay.
Our hypothesis was partially confirmed. No conversion to laparotomy nor intraoperative or postoperative blood transfusions were needed. Patients with heavier uteri statistically had longer operative times. We found no significative difference in length of hospital stay. The difference in blood losses between groups were statistically, but not clinically, significant. Although the study was underpowered to assess differences in postoperative complications, grade I-II and grade IIIa complications resulted equally distributed between the study groups.
In high-volume centers hysterectomy for very enlarged uteri can be successfully performed robotically, considering that such cases require longer operative time.