Transvaginal robotic-assisted natural orifice laparoscopic hysterectomy for benign gynecologic disease: Determining appropriate candidates

Objective: The purpose of this study is to examine the feasibility and identify the candidates of transvaginal robotic-assisted laparoscopic hysterectomy (tVRALH) for gynecologic benign diseases. Materials and methods: A total of 154 robotic-assisted laparoscopic hysterectomy (RALH) and 57 tVRALH procedures were reviewed for individual patient demographics and operative outcomes. Operative blood loss (BL), operating time (OT), intraoperative blood transfusion, surgical complication, and postoperative hospitalization length were evaluated based on corresponding clinical characteristics including age, body mass index (BMI), history of vaginal delivery and cesarean delivery, previous abdominal surgery and specimen weight. Results: Patients in the tVRALH group had a lower BMI (p = 0.033), a higher proportion of history of vaginal delivery (p < 0.001), a lower proportion of history of cesarean delivery (p = 0.004), lighter uterine weight (p < 0.001), less BL (p < 0.005), and shorter OT (p < 0.001) compared to RALH group. There was no significant difference between the two groups in terms of the requirement for blood transfusion, overall incidence of operative complications, or length of postoperative stay. However, patients who underwent tVRALH experienced a higher incidence of transient hematuria (12.3 % vs. 0.6 %, p < 0.001). Multivariate regression analysis confirmed that BMI and the uterine weight were significantly associated with the OT and the BL in the RALH group. The history of cesarean delivery was also significantly associated with the OT. No parameter was observed to be significantly associated with the BL and the OT in the tVRALH group. Conclusion: The history of vaginal delivery and uterine size may influence a surgeon's decision to choose tVRALH for treating patients with benign uterine diseases. Additionally, surgeons should be aware of the potential occurrence of transient intraoperative hematuria during the procedure.