Uterine Weight and Perioperative Morbidity in Robotic-Assisted versus Conventional Laparoscopic Hysterectomy

Minimally invasive approaches to benign hysterectomy are the current standard of care when feasible. Use of robotic-assisted laparoscopic hysterectomy (RA-LH) has been increasing; however, direct comparative data that accounts for uterine weight in conventional laparoscopic hysterectomy (CLH) and RA-LH is limited. We sought to examine the impact of uterine weight on immediate perioperative morbidity in CLH versus RA-LH. The primary outcome was a composite of complications including visceral injuries, conversions to abdominal procedures, and transfusions.

A retrospective cohort study of patients who underwent a minimally invasive laparoscopic hysterectomy (CLH and RA-LH) in a single hospital system between January 1, 2014 and December 31, 2017 as identified by Current Procedural Terminology codes. The primary exposure was CLH or RA-LH. Uterine weight was categorized into four groups: <150 g, 150 to < 250 g, 250 to < 450 g, and ≥ 450 g.

A total of 1506 patients were included; 539 underwent CLH and 967 underwent RA-LH. Median uterine weight was higher in patients who underwent CLH (161.0 g) compared to RA-LH (147.0 g), P = .001. The odds of the composite of complications in CLH was 4.43 (2.84 - 6.92) higher than the odds of the composite in RA-LH. When stratified by the uterine weight, the odds of complications was significantly higher in CLH in the following categories: <150 g, 250 to < 450 g, and ≥ 450 g (OR: 4.41, 3.28, and 7.81, respectively).

Surgical morbidity was lower in RA-LH across the spectrum of uterine weights compared to CLH. Patients may particularly benefit from RA-LH at higher uterine weights.