Journal of Robotic Surgery

, Volume 12, Issue 4, pp 641–645 | Cite as

Perioperative outcomes of robotic hysterectomy with mini-laparotomy versus open hysterectomy for uterus weighing more than 250 g

  • Natasha Gupta
  • Shanti Mohling
  • Rebecca Mckendrick
  • Rayan Elkattah
  • Jenny Holcombe
  • Robert S. Furr
  • Todd Boren
  • Stephen DePasquale
Original Article


To compare perioperative outcomes in patients undergoing robotic hysterectomy and extraction of specimen via mini-laparotomy (RHML) versus open hysterectomy (OH) when uterus weighs more than 250 g. To study the factors determining the length of hospital stay in 2 groups. A retrospective analysis of all hysterectomies performed for uterus weighing more than 250 g from the year 2012 to 2015 was conducted. A total of 140 patients were divided into 2 groups based on the type of surgery; RHML (n = 82) and OH (n = 58). Mini-laparotomy consisted of a customised incision connecting 2 left lateral port sites for specimen extraction after completing the hysterectomy robotically. Patient factors and perioperative outcomes were compared using Student’s t tests and Chi-square analysis. Mean length of stay (RHML = 1.4 days; OH = 3.4 days), estimated blood loss (EBL) (RHML = 119.9 ml; OH = 547.5 ml) and operative time (RHML = 191.5 min; OH = 162.8 min) were significantly different. No significant differences were noted for patient BMI, age, comorbidities, intraoperative complications, pathology of uterus and uterus weight. Postoperative complications were significantly different between two groups (RHML = 6.0%; OH = 15.5%; p = .021). None of the patients stayed less than 24 h in OH group compared to 59.8% patients in RHML group. Type of procedure (p = .004) and EBL (p = .002) significantly predicted the length of stay. Patients undergoing RHML have significantly shorter length of stay, EBL and postoperative complications than OH. The operative time for RHML was longer than OH, but the overall decreased length of stay overcomes this disadvantage. RHML approach retains the benefits of da Vinci, while simultaneously preserving the specimen.


Robotic surgery Hysterectomy Large uteri Mini-laparotomy Morcellation Specimen removal 


Compliance with ethical standards

Conflict of interest

Natasha Gupta, Shanti Mohling, Rebecca Mckendrick M.Sc, Rayan Elkattah, Jenny Holcombe, Robert S. Furr, Todd Boren and Stephen DePasquale declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  • Natasha Gupta
    • 1
    • 3
  • Shanti Mohling
    • 1
  • Rebecca Mckendrick
    • 1
    • 2
  • Rayan Elkattah
    • 1
  • Jenny Holcombe
    • 1
    • 2
  • Robert S. Furr
    • 1
  • Todd Boren
    • 2
  • Stephen DePasquale
    • 2
  1. 1.Minimally Invasive Gynecologic Surgery, Department of Obstetrics and GynecologyUniversity of Tennessee College of MedicineChattanoogaUSA
  2. 2.Department of Gynecologic OncologyUniversity of Tennessee College of MedicineChattanoogaUSA
  3. 3.Dept. of Obstetrics and GynecologyErlanger Health SystemChattanoogaUSA

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