CHICAGO – Surgeons tended to select women who were significantly older and thinner and who had a smaller uterine size for robotic total hysterectomy in a retrospective analysis of 380 women.
Women who underwent robotic total hysterectomy averaged 51 years of age, compared with 44 years among women who underwent laparoscopic total hysterectomy. They had a body mass index of 27.4 vs. 29.8 kg/m2, and had a lower uterine weight at 144 g vs. 204 g (P value less than .001 for all outcomes), Dr. Liza Colimon and her colleagues reported in a poster at the annual meeting of the International Pelvic Pain Society.
Charts were reviewed for information regarding pain levels and analgesic use among 162 women who underwent robotic total hysterectomy and 218 women who had laparoscopic total hysterectomy at three urban teaching hospitals in the Southeast in 2008-2009. All surgeries were performed by gynecologists or gynecologic oncologists for benign indications.
Women undergoing laparoscopic hysterectomy were significantly more likely to have a higher intraoperative blood loss and to stay in the hospital longer than were those undergoing the robotic-assisted approach, reported Dr. Colimon of the department of ob.gyn. at the Florida Hospital in Orlando.
Mean estimated intraoperative blood loss was 168 mL in the laparoscopic group, compared with 70 mL in the robotic group. Average length of stay was 1.2 days vs. 0.7 days, respectively. Hemoglobin levels at discharge were also significantly lower in the laparoscopic group at 10.7 g/dL vs. 12.1 g/dL in the robotic group.
In spite of this, pain levels were similar in the two groups, but the incidence of patient-controlled analgesia was significantly higher in the laparoscopic group, the researchers noted. Mean pain scores that were assessed postoperatively on a 10-point visual analogue scale were 5.5 for the robotic group and 5.7 for the laparoscopic group, and 2.1 vs. 2.0 at discharge.
The incidence of patient-controlled analgesia was 14.6% among the laparoscopic group, whereas no patients treated with the robotic-assisted approach required patient-controlled analgesia. This finding may be because the laparoscopic group had a longer hospital stay or surgeon preference, Dr. Colimon suggested.
The researchers received support from Florida Hospital Continuing Medical Education. Dr. Colimon disclosed no relevant conflicts of interest.