Innovative classification system for enlarged uterus in laparoscopic and robotic hysterectomy with complications and...

The aim of this study was to compare the surgical outcomes of robot-assisted hysterectomy (RAH) with those of conventional laparoscopic hysterectomy (CLH) for large uteri via a novel classification system. Ambispective analysis of 237 cases was performed, comprising 90 retrospectively reviewed cases and 147 prospectively enrolled cases. Patients were categorized into two main groups based on surgical procedure (RAH and CLH) and three subgroups each (type 1 (T1), type 2 (T2), and type3 (T3)) based on uterine size. Key outcomes, including the operative time and perioperative complications, were analyzed. Quality of life was assessed using the EuroQol-5 Dimensions and the Female Sexual Function Index questionnaires. The surgeon's learning curve was evaluated using surgical data. Among 237 patients, 47.3% underwent RAH and 52.7% underwent CLH. RAH was preferred for larger uteri (T3: 888.8 ± 136 g) vs. CLH (T3: 778.8 ± 83.7 g, P < 0.001). However, compared with CLH, RAH had a longer operative time, lower blood loss (RAH, T3: 107.8 ± 69.8 mL vs. CLH, T3 309 ± 248.4 mL, P < 0.001), better hemoglobin recovery, and shorter hospitalization (P < 0.05). Most of the complications (ureteric injury, laparotomy conversion, gastrointestinal injuries) occurred only in the CLH group, whereas vascular and bladder injuries were observed in both groups. Pain scores normalized by the 4th week, patient satisfaction was greater in RAH group (RAH 75.3% vs CLH 72.3%), and sexual function was comparable. Surgeon's experience improved over time, especially for large uteri. RAH is associated with more favorable outcomes than CLH, especially with regard to larger uteri (T3).