Table 4 Results of the questionnaire completed 2 months after surgery expressed as mean �� SD and number (%). 4. Discussion Robotically assisted surgery offers Paclitaxel advantages over laparoscopy in hysterectomy procedures for benign disease. The princeps series of Payne and Dauterive [7] showed beneficial results regarding uterine weight, operative time in the 25 last procedures (series of 100 cases), blood loss, laparoconversions, and hospital stay duration. This author confirmed such results in a meta-analysis [8]. The rate of vaginal cuff dehiscence has been probably overestimated in the first series [9]; it appears to be 1.5% like that observed with laparoscopy [10]. We had no cases of dehiscence in our series: only one case of pelvic abscess that resolved after antibiotherapy.
A comparative study of RH and laparoscopic-assisted VH showed that the robotic procedure reduces the operative time and duration of hospital stay with less blood loss [11]. Very few studies have compared RH and VH [12�C15]. Matthews et al. carried out a retrospective analysis of the various surgical approaches used in their department during the first year after robotic equipment was introduced in this unit [12]. They observed beneficial results associated with the robot regarding blood loss, transfusion rate, and infection rate. In another retrospective series, Landeen et al. [15] compared all surgical approaches for hysterectomy; they underline less blood loss with the robot and reduced hospital stay, while VH was associated with a shortened operative time and reduced cost of the procedure.
The two other comparisons were reported in congress abstracts [13, 14]. We found no randomized study or prospective study on this comparison. Our results are in accordance with those reported in the literature regarding blood loss and duration of hospital stay. We observed also a lengthened operative time with the robotic procedure. Our study reports no significant difference between the two procedures regarding intra- and postoperative complications; in fact, hysterectomy in benign disease is usually associated with a low incidence of complications, and no difference could be evidenced with such small sample. We also focused on postoperative pain, a fact poorly present in the literature, although some authors have underlined the beneficial outcome of laparoscopy over VH regarding postoperative pain [4].
Our study reports less postoperative pain associated with the robotic approach at D1 and D2 on the rating scale and lower analgesic level at D2. Such results were not seen at D3, probably biased by the discharge of a great number of RH patients at D2. We observed no difference in terms Dacomitinib of morphine consumption. Morphine-like agents are primarily used in the recovery room and may have been overused at first interventions carried out in the department, making our results possibly biased.