Robotic versus open hysterectomy for very large uterus (more than 1000 g): A bicentric retrospective study of 150 patients.

Objective: To compare robotic (RAL) and open abdominal (OA) hysterectomy for very large uteri in terms of perioperative outcomes, complications, and costs.

Methods: Data from patients undergoing total hysterectomy between 2015 and 2021 for benign indications with a uterus weighing 1000 g or more according to the pathology report in two French Academic hospitals were retrospectively collected. All patients with a malignant pathology were excluded.

Results: Among 150 patients included, 44 (30%) patients underwent RAL and 106 (70%) underwent OA hysterectomies. Mean uterus weights were 1844 g in the OA group and 1710 g in the RAL group. Mean operative time was longer in the RAL group (217 vs. 124 min; P < 0.001). No difference was found in terms of intraoperative (P = 0.951) and postoperative complications (P = 0.680). Hospital stay was shorter in the RAL group (1.6 vs. 3.8 days; P < 0.001). The RAL route was more expensive than the OA route regarding operating room occupancy (€1339 vs. €2370; P < 0.001) and disposable instruments (€390 vs. €654; P < 0.001); but cheaper, regarding the cost of hospital stay (€5042 vs. €9119; P < 0.001), which led to a lower global cost with the RAL route (€8211 vs. €10 901; P < 0.001).

Conclusion: Robotic hysterectomy for uteri weighing more than 1000 g is comparable with open hysterectomy in terms of complications. The robotic approach allows for a shorter hospital stay, which leads to a lower overall cost.