Patient Outcomes with Robotic-Assisted Total Laparoscopic Hysterectomy Versus Robotic-Assisted Total Laparoscopic Hysterectomy with Minilaparotomy

Introduction: Minimally invasive hysterectomy, with removal of the specimen through the vagina, has minimal morbidity and superior intraoperative and postoperative outcomes compared to abdominal hysterectomy. There are times, however, when vaginal specimen removal may not be feasible, and a minilaparotomy can be utilized. The purpose of this study was to compare outcomes of robotic-assisted total laparoscopic hysterectomies with vaginal specimen extraction (RV) versus minilaparotomy specimen extraction (RL). Methods: A retrospective cohort study was conducted among two groups of patients who underwent a robotic-assisted total laparoscopic hysterectomy with RV or RL by the gynecological oncology service at an academic institution. Blood loss, pain medication requirements, length of stay, and surgical complications were compared between groups. Results: From January 2017 to October 2022, 1643 patients underwent a robotic hysterectomy. Sixty patients required a minilaparotomy for specimen extraction versus 1583 patients who had a vaginal extraction. RL cases had a larger BL (114.8 mL vs. 60.0 mL, p < 0.001), morphine milligram equivalents requirements (95.8 vs. 84.2, p = 0.018), and length of stay (1.5 vs. 1.2 days, p < 0.001) when compared to RV cases. Postoperative complications were more common in malignant RL cases compared to malignant RV extraction cases ( p -value = 0.028). Conclusion: Despite a statistical increase in BL, pain medication needs, and length of stay, these outcomes were of limited clinical significance, and overall, RL was found to be a safe option for specimen removal when vaginal extraction is not feasible.