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Incorporating Resident Training in Developing a Robotic Program
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Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S178–S188
SCIENTIFIC VIRTUAL POSTER PRESENTATIONS PART3 POSTER SESSIONdROBOTICS 601 Risk Factors for Extended Length of Stay in Patients Undergoing a Laparoscopic Supracervical Hysterectomy Ascher-Walsh CJ,1 Capes TL,1 Sekhon LH.2 1Obstetrics and Gynecology, Mt. Sinai School of Medicine, New York, New York; 2Royal College of Surgeons in Ireland, Dublin, 2, Ireland Study Objective: To assess pre-operative and operative data to determine risk factors for extended lenght of stay in patients undergoing a laparoscopic supracervical hysterectomy. Design: Retrospective chart review study. Setting: University Hospital. Patients: 136 women undergoing laparoscopic supracervical hysterectomy from 1/07 through 2/10 performed by the same surgeon. Intervention: Patients scheduled for laparoscopic supracervical hysterectomy were scheduled for outpatient treatment. They were reassessed in the recovery room and given the option to stay if the pain was considered too great to leave the hospital. Measurements and Main Results: The following pre-operative and operative data were assessed: age, parity, BMI, pre-operative Hct, Duration, EBL, uterine mass. Duration, EBL and uterine weight were all found to be associated with extended length of stay. Comparison of average data between outpatient and inpatient Laparoscopic supracervical hysterectomy patients
number of patients BMI Parity EBL uterine weight age pre-op Hct Duration
Same day discharge
Length of stay R1 day
p value
44 25.95 1.38 210.11 463.44 47.25 35.6 128.95
92 26.62 1.40 272.24 590.48 47.06 35.4 144.43
0.67 0.77 0.04 0.05 0.82 0.64 0.04
Conclusion: The length of the surgery, amount of blood loss and size of the uterus are all predictors of increased post-operative pain requiring a prolonged hospital stay in patients undergoing laparoscopic supracervical hysterectomy. 602 Disseminated Peritoneal Leiomyomatosis Surgically Treated Using Robotics Atkin RP, Prabakar C, Nimaroff ML. OB/GYN, North Shore University Hospital, Manhasset, New York Study Objective: A a rare case presentation of Disseminated Peritoneal Leiomyomatosis (DPL) that was treated with surgical management using the Da Vinci Robot. Design: Case report. Setting: University Hospital. Patients: The patient presented to us with pelvic pain and has a history significant for uterine fibroids treated with a laparoscopic myomectomy five years prior to her consultation. On pelvic sonogram a normal uterus and right adnexal mass were observed . On laparoscopic exam multiple parasitic myomas were found in her pelvis. Intervention: We were able to optimally debulk this patient using the Da Vinci Robot. The parasitic myomas were large and densely adhered to the rectum and ureters requiring fine, careful and complete manipulation, dissection with optimal visualization. Conclusion: The robot was an asset to the success of this surgery enabling this patient to benefit from a minimally invasive procedure. To our knowledge using the robot to surgically debulk DPL has yet to be reported in the literature.
603 Robotic Radical Hysterectomy Versus Total Laparoscopic Radical Hysterectomy: Using Nerve Sparing Technique Performed by a Single Surgeon Chong GO, Park NY, Hong DG, Cho YL, Park IS, Lee YS. Obstetrics and Gynecology, Kyungpook National University Hospital, Daegu, Korea Study Objective: To compare surgical outcome of robotic radical hysterectomy (RRH) with total laparoscopic radical hysterectomy (TLRH) in the treatment of cervical cancer. Design: Retrospective historic cohort study. Setting: Academic teaching hospital. Patients: Twenty patients who underwent TLRH or RRH for the treatment cervical cancer (FIGO stage IA2 – IIA). Intervention: The first 10 patients who underwent TLRH, and the first 10 patients who underwent RRH. Measurements and Main Results: Both group were similar with respect to age (48.9 years vs 47.6 years; P=0.684), body mass index (24.7 kg/m2 vs 24.1 kg/m2; P=0.436), length of hospital stay (7.4 days vs 9.5 days; P=0.143), time to normal residual urine (8.7 days vs 10.0 days P=0.684)), and acquired number of pelvic lymph nodes (25.5 vs 19.8; P=0.089). The mean operating time of TLRH group was significantly shorter than that of RRH group (198.1 min vs 242.0 min; P=0.003). However, the mean blood loss was significantly lower in the RRH group than in the TLRH group (285.0 mL vs 22.5 mL; P=0.000). There were no significant intra- and postoperative complications in the 2 groups. Conclusion: Although our limited experience, the mean blood loss of RRH group was significantly less than that of TLRH group. Robotic system has several advantages such as, more comfortable in dissection, especially deep in the cardinal ligament and vesicouterine ligament, and more stable in laparoscopic view the deep in pelvis, especially the inferior hypogastric plexus.
604 Incorporating Resident Training in Developing a Robotic Program Green MA, DellaBadia C. Dept of OB/GYN, Drexel University College of Medicine, Philadelphia, Pennsylvania Study Objective: Learning the DaVinci robotic system for gynecologic procedures can be challenging. At our institution, we have residents and a minimally invasive gynecology fellowship. The transition was difficult when robotics was incorporated into our surgical realm. We developed a curriculum to gradually introduce and educate residents about this new technology. Design: Robotic resident training program. Setting: University institution. Intervention: Once we performed between 20-30 cases over a 3-4 month period, we felt comfortable. During our learning curve, we had frequent resident turnover. This presented challenges with improving efficiency because residents had varying experience levels. The bedside resident was relegated to assisting under the guidance of the fellow. This included holding the uterine manipulator at awkward positions, suctioning, and feeding suture to the robotic surgeon. After our initial cases, we realized that interns were delegated to scrub into our cases. Senior residents weren’t scrubbing our cases because of lack of interest and minimal participation with this robotic technology. We organized a joint multidisciplinary minimally invasive surgery conference with the gynecology, urology and surgery departments. We discuss pertinent topics in minimally invasive surgery relevant to all disciplines. Residents are exposed to didactic and clinical aspects of robotics. Measurements and Main Results: At the beginning of each rotation, we set up hands-on sessions on the DaVinci system for resident participation. Junior residents learn basic skills: docking, instrument exchange, feeding suture, suctioning and use of simulators. Senior residents gradually perform key portions of the procedure. As they progress and attain the necessary skills, they’re allowed more autonomy.
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S178–S188 Conclusion: Residents became increasingly motivated and enthusiastic about robotics. By the end of their rotation, they feel comfortable using the DaVinci system. Other attendings in our department became eager to pursue robotic training. Our program resulted in improved bedside assistance. Our efficiency has improved during procedures and ultimately has helped the residents become better laparoscopic surgeons.
605 Three Port Robotic Hysterectomy Using Harmonic Scapel Holland LJ, Galloway M, Dhanraj D. Minimally Invasive Fellowship, Miami Valley Hospital, Dayton, Ohio Study Objective: To evaluate the efficacy and safety of a three port robotic hysterectomy using Harmonic scalpel in women with indications for definitive surgical therapy. Design: Prospective study of 11 consecutive cases of Robotic Assisted Total Laparoscopic Hysterectomy with and without Bilateral SalpingoOophorectomy. Setting: Tertiary care hospital (Miami Valley Hospital); the first author involved in Minimally Invasive Surgery Fellowship program at Wright State University. Patients: Eleven women (ages 25-52) with surgical indications for hysterectomy. Intervention: All patients underwent a DaVinci robotic assisted Total laparoscopic Hysterectomy using only three access ports. A single surgeon with extensive laparoscopic proficiency but novice robotic skills performed all the procedures with Harmonic Scalpel. Measurements and Main Results: All eleven women completed the surgery and appropriate follow-up. The mean BMI was 28.59 (range 19.57-41.11). The mean pre and post Hemoglobin was 13.6 and 11.7 respectively. The mean blood loss was 66cc (range \20-150). Several time variables were measured as well. The mean time for the vaginal portion was 6.4 minutes (range 3-13). The mean time for trocar placement was 5.6 minutes (range 2-10). The mean docking time was 4.2 minutes (range 2-10). The mean console time was 53.4 minutes (range 33-91 minutes). The mean trocar to closure time was 73.3 minutes (range 49-119). The only complication was a missing intraperitoneal needle in one case which added several minutes to be retrieved. Surgical data Patient BMI EBL
Vaginal (min)
Trocar (min)
Docking Console Tro-closure (min) (min) (min)
1 2 3 4 5 6 7 8 9 10 11 Mean
4 13 4 4 3 4 9 10 5 4 8 6.18
3 2 6 2 10 7 5 7 3 9 2 5.09
2 3 3 8 9 5 4 3 8 4 3 4.72
23.41 25.11 36.9 25.52 22.65 41.11 22.33 38.17 27.41 32.37 19.57 28.59
60 50 50 50 100 50 50 150 20 100 50 66.36
63 46 45 46 69 41 45 47 33 91 61 53.36
77 61 61 64 95 89 66 66 48 115 75 74.27
Conclusion: In our hands a three port robotic hysterectomy using Harmonic scalpel was a safe and efficient option for surgical intervention and a more acceptable cosmetic outcome for the patients. 606 Perioperative Outcomes of Robotically Assisted Hysterectomy in Comparison to Total Laparoscopic Hysterectomy and Vaginal Hysterectomy for Benign Cases Moore GE, Radecki C, Borahay MA, Kilic SG. Department of Obstetrics and Gynecology, University of Texas Medical Branch-Galveston, Galveston, Texas
S179
Study Objective: To report on the perioperative outcomes after robotic, total laparoscopic, and vaginal hysterectomy for benign indications in a teaching institution. Design: Prospective Comparative Analysis. Setting: Southeastern Texas medical institution serving primarily indigent, high risk population. Patients: A total of sixty-seven patients requiring hysterectomy for nonmalignant reasons were included. Intervention: Patients underwent robotic, laparoscopic, and vaginal hysterectomy for noncancerous indications from April 2008 to January 2010. All cases were performed, or supervised, by the same surgeon. Of note, the robotic cases were the first twenty cases for the surgeon. Measurements and Main Results: Prospective documentation of intraoperative data, systematic chart review, and postoperative follow up was conducted based on preoperative and perioperative characteristics of each patient. Each case was evaluated for its complexity based on preoperative diagnosis, prior pelvic or abdominal surgery, body mass index, and uterine weight. Hysterectomy (laparoscopic n=34, robotic n=24, vaginal n=9) was performed on 67 (9 Hispanic, 38 white, 20 black) women. Women were 27 to 64 years of age (M=44.25 8.9), with a BMI between 19.3 and 54.7 (M=32.4 7.6). Approximately 72% of the sample (n=48) had a history of previous surgery. In the total sample, operative time (minutes) ranged from 70 to 452 (M=206.12 64.08), with an average hospital stay of 2.09 days (1 day, range 1-5 days). Estimated blood loss (cc) ranged from 20 to 1000 (M=204.63 176.49). Uterine weight (g) ranged from 35 to 905 (M=188.52 153.32). Type of surgery (laparoscopic, robotic, vaginal) was unrelated to BMI, operative time, and length of hospital stay (all P >0.05). Type of surgery was related to estimated blood loss (P \0.05) and uterine weight (P \0.01). Conclusion: Robotically assisted hysterectomy for benign indications in patients with complex pathology is feasible, with low morbidity and short hospital stay. This study suggests that robotic assistance facilitates the use of a minimally invasive approach in high-risk patient populations.
607 Does Size Matter? The Effect of Uterine Weight on Robotic Assisted Total Laparoscopic Hysterectomy Outcomes Orady ME,1 Nawfal AK,1 Wegienka G.2 1Obstetrics and Gynecology/ Women’s Health Services, Henry Ford Medical Center, Detroit, Michigan; 2 Biostatistics and Research Epidemiology, Henry Ford Medical Center, Detroit, Michigan Study Objective: To determine whether benefits of robotic assisted total laparoscopic hysterectomy (RH) extend across the spectrum of uterine sizes. Design: Retrospective Cohort Study. Setting: Henry Ford Health System’s Community Teaching Hospitals. Patients: 110 patients who underwent RH for benign indications, at one of two hospitals, between January 2008 and February 2010. Intervention: Scheduled RH without concomitant urogynecologic procedures as the intention to treat. Measurements and Main Results: Patient demographics, height, weight, age, estimated blood loss (EBL), procedure duration, uterine weight, pathology, length of hospital stay (LOS) and Immediate and delayed complications were obtained from a detailed review of the Electronic Medical Record. Uterine weight ranged from 47-1020 grams (\250 grams, n=71; 250-500 grams, n=24; >500 grams, n=13). Most women had a LOS of 1 day (n=73, 66.4%), 25 women had a LOS of 2 days (22.7%), and 12 women had a LOS of greater than 2 days (10.9%). Overall, the uterine weight was highly correlated with procedure duration (Spearman correlation, r=0.51, p\0.001.). Median procedure duration increased from 154 minutes in the \ 250 gram group, to 201 minutes in the 250-500 gram group, to 294 minutes in the >500 gram group. Uterine weight was also moderately correlated with EBL (Spearman correlation r=0.29, p=0.003). Median EBL increased from 50 ml (\250 g group) to 100 ml in both the 250-500 gram and >500 gram groups. This was also reflected in the assessment of decrease in perioperative hemoglobin. Uterine weight was not correlated with LOS
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S178–S188
SCIENTIFIC VIRTUAL POSTER PRESENTATIONS PART3 POSTER SESSIONdROBOTICS 601 Risk Factors for Extended Length of Stay in Patients Undergoing a Laparoscopic Supracervical Hysterectomy Ascher-Walsh CJ,1 Capes TL,1 Sekhon LH.2 1Obstetrics and Gynecology, Mt. Sinai School of Medicine, New York, New York; 2Royal College of Surgeons in Ireland, Dublin, 2, Ireland Study Objective: To assess pre-operative and operative data to determine risk factors for extended lenght of stay in patients undergoing a laparoscopic supracervical hysterectomy. Design: Retrospective chart review study. Setting: University Hospital. Patients: 136 women undergoing laparoscopic supracervical hysterectomy from 1/07 through 2/10 performed by the same surgeon. Intervention: Patients scheduled for laparoscopic supracervical hysterectomy were scheduled for outpatient treatment. They were reassessed in the recovery room and given the option to stay if the pain was considered too great to leave the hospital. Measurements and Main Results: The following pre-operative and operative data were assessed: age, parity, BMI, pre-operative Hct, Duration, EBL, uterine mass. Duration, EBL and uterine weight were all found to be associated with extended length of stay. Comparison of average data between outpatient and inpatient Laparoscopic supracervical hysterectomy patients
number of patients BMI Parity EBL uterine weight age pre-op Hct Duration
Same day discharge
Length of stay R1 day
p value
44 25.95 1.38 210.11 463.44 47.25 35.6 128.95
92 26.62 1.40 272.24 590.48 47.06 35.4 144.43
0.67 0.77 0.04 0.05 0.82 0.64 0.04
Conclusion: The length of the surgery, amount of blood loss and size of the uterus are all predictors of increased post-operative pain requiring a prolonged hospital stay in patients undergoing laparoscopic supracervical hysterectomy. 602 Disseminated Peritoneal Leiomyomatosis Surgically Treated Using Robotics Atkin RP, Prabakar C, Nimaroff ML. OB/GYN, North Shore University Hospital, Manhasset, New York Study Objective: A a rare case presentation of Disseminated Peritoneal Leiomyomatosis (DPL) that was treated with surgical management using the Da Vinci Robot. Design: Case report. Setting: University Hospital. Patients: The patient presented to us with pelvic pain and has a history significant for uterine fibroids treated with a laparoscopic myomectomy five years prior to her consultation. On pelvic sonogram a normal uterus and right adnexal mass were observed . On laparoscopic exam multiple parasitic myomas were found in her pelvis. Intervention: We were able to optimally debulk this patient using the Da Vinci Robot. The parasitic myomas were large and densely adhered to the rectum and ureters requiring fine, careful and complete manipulation, dissection with optimal visualization. Conclusion: The robot was an asset to the success of this surgery enabling this patient to benefit from a minimally invasive procedure. To our knowledge using the robot to surgically debulk DPL has yet to be reported in the literature.
603 Robotic Radical Hysterectomy Versus Total Laparoscopic Radical Hysterectomy: Using Nerve Sparing Technique Performed by a Single Surgeon Chong GO, Park NY, Hong DG, Cho YL, Park IS, Lee YS. Obstetrics and Gynecology, Kyungpook National University Hospital, Daegu, Korea Study Objective: To compare surgical outcome of robotic radical hysterectomy (RRH) with total laparoscopic radical hysterectomy (TLRH) in the treatment of cervical cancer. Design: Retrospective historic cohort study. Setting: Academic teaching hospital. Patients: Twenty patients who underwent TLRH or RRH for the treatment cervical cancer (FIGO stage IA2 – IIA). Intervention: The first 10 patients who underwent TLRH, and the first 10 patients who underwent RRH. Measurements and Main Results: Both group were similar with respect to age (48.9 years vs 47.6 years; P=0.684), body mass index (24.7 kg/m2 vs 24.1 kg/m2; P=0.436), length of hospital stay (7.4 days vs 9.5 days; P=0.143), time to normal residual urine (8.7 days vs 10.0 days P=0.684)), and acquired number of pelvic lymph nodes (25.5 vs 19.8; P=0.089). The mean operating time of TLRH group was significantly shorter than that of RRH group (198.1 min vs 242.0 min; P=0.003). However, the mean blood loss was significantly lower in the RRH group than in the TLRH group (285.0 mL vs 22.5 mL; P=0.000). There were no significant intra- and postoperative complications in the 2 groups. Conclusion: Although our limited experience, the mean blood loss of RRH group was significantly less than that of TLRH group. Robotic system has several advantages such as, more comfortable in dissection, especially deep in the cardinal ligament and vesicouterine ligament, and more stable in laparoscopic view the deep in pelvis, especially the inferior hypogastric plexus.
604 Incorporating Resident Training in Developing a Robotic Program Green MA, DellaBadia C. Dept of OB/GYN, Drexel University College of Medicine, Philadelphia, Pennsylvania Study Objective: Learning the DaVinci robotic system for gynecologic procedures can be challenging. At our institution, we have residents and a minimally invasive gynecology fellowship. The transition was difficult when robotics was incorporated into our surgical realm. We developed a curriculum to gradually introduce and educate residents about this new technology. Design: Robotic resident training program. Setting: University institution. Intervention: Once we performed between 20-30 cases over a 3-4 month period, we felt comfortable. During our learning curve, we had frequent resident turnover. This presented challenges with improving efficiency because residents had varying experience levels. The bedside resident was relegated to assisting under the guidance of the fellow. This included holding the uterine manipulator at awkward positions, suctioning, and feeding suture to the robotic surgeon. After our initial cases, we realized that interns were delegated to scrub into our cases. Senior residents weren’t scrubbing our cases because of lack of interest and minimal participation with this robotic technology. We organized a joint multidisciplinary minimally invasive surgery conference with the gynecology, urology and surgery departments. We discuss pertinent topics in minimally invasive surgery relevant to all disciplines. Residents are exposed to didactic and clinical aspects of robotics. Measurements and Main Results: At the beginning of each rotation, we set up hands-on sessions on the DaVinci system for resident participation. Junior residents learn basic skills: docking, instrument exchange, feeding suture, suctioning and use of simulators. Senior residents gradually perform key portions of the procedure. As they progress and attain the necessary skills, they’re allowed more autonomy.
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S178–S188 Conclusion: Residents became increasingly motivated and enthusiastic about robotics. By the end of their rotation, they feel comfortable using the DaVinci system. Other attendings in our department became eager to pursue robotic training. Our program resulted in improved bedside assistance. Our efficiency has improved during procedures and ultimately has helped the residents become better laparoscopic surgeons.
605 Three Port Robotic Hysterectomy Using Harmonic Scapel Holland LJ, Galloway M, Dhanraj D. Minimally Invasive Fellowship, Miami Valley Hospital, Dayton, Ohio Study Objective: To evaluate the efficacy and safety of a three port robotic hysterectomy using Harmonic scalpel in women with indications for definitive surgical therapy. Design: Prospective study of 11 consecutive cases of Robotic Assisted Total Laparoscopic Hysterectomy with and without Bilateral SalpingoOophorectomy. Setting: Tertiary care hospital (Miami Valley Hospital); the first author involved in Minimally Invasive Surgery Fellowship program at Wright State University. Patients: Eleven women (ages 25-52) with surgical indications for hysterectomy. Intervention: All patients underwent a DaVinci robotic assisted Total laparoscopic Hysterectomy using only three access ports. A single surgeon with extensive laparoscopic proficiency but novice robotic skills performed all the procedures with Harmonic Scalpel. Measurements and Main Results: All eleven women completed the surgery and appropriate follow-up. The mean BMI was 28.59 (range 19.57-41.11). The mean pre and post Hemoglobin was 13.6 and 11.7 respectively. The mean blood loss was 66cc (range \20-150). Several time variables were measured as well. The mean time for the vaginal portion was 6.4 minutes (range 3-13). The mean time for trocar placement was 5.6 minutes (range 2-10). The mean docking time was 4.2 minutes (range 2-10). The mean console time was 53.4 minutes (range 33-91 minutes). The mean trocar to closure time was 73.3 minutes (range 49-119). The only complication was a missing intraperitoneal needle in one case which added several minutes to be retrieved. Surgical data Patient BMI EBL
Vaginal (min)
Trocar (min)
Docking Console Tro-closure (min) (min) (min)
1 2 3 4 5 6 7 8 9 10 11 Mean
4 13 4 4 3 4 9 10 5 4 8 6.18
3 2 6 2 10 7 5 7 3 9 2 5.09
2 3 3 8 9 5 4 3 8 4 3 4.72
23.41 25.11 36.9 25.52 22.65 41.11 22.33 38.17 27.41 32.37 19.57 28.59
60 50 50 50 100 50 50 150 20 100 50 66.36
63 46 45 46 69 41 45 47 33 91 61 53.36
77 61 61 64 95 89 66 66 48 115 75 74.27
Conclusion: In our hands a three port robotic hysterectomy using Harmonic scalpel was a safe and efficient option for surgical intervention and a more acceptable cosmetic outcome for the patients. 606 Perioperative Outcomes of Robotically Assisted Hysterectomy in Comparison to Total Laparoscopic Hysterectomy and Vaginal Hysterectomy for Benign Cases Moore GE, Radecki C, Borahay MA, Kilic SG. Department of Obstetrics and Gynecology, University of Texas Medical Branch-Galveston, Galveston, Texas
S179
Study Objective: To report on the perioperative outcomes after robotic, total laparoscopic, and vaginal hysterectomy for benign indications in a teaching institution. Design: Prospective Comparative Analysis. Setting: Southeastern Texas medical institution serving primarily indigent, high risk population. Patients: A total of sixty-seven patients requiring hysterectomy for nonmalignant reasons were included. Intervention: Patients underwent robotic, laparoscopic, and vaginal hysterectomy for noncancerous indications from April 2008 to January 2010. All cases were performed, or supervised, by the same surgeon. Of note, the robotic cases were the first twenty cases for the surgeon. Measurements and Main Results: Prospective documentation of intraoperative data, systematic chart review, and postoperative follow up was conducted based on preoperative and perioperative characteristics of each patient. Each case was evaluated for its complexity based on preoperative diagnosis, prior pelvic or abdominal surgery, body mass index, and uterine weight. Hysterectomy (laparoscopic n=34, robotic n=24, vaginal n=9) was performed on 67 (9 Hispanic, 38 white, 20 black) women. Women were 27 to 64 years of age (M=44.25 8.9), with a BMI between 19.3 and 54.7 (M=32.4 7.6). Approximately 72% of the sample (n=48) had a history of previous surgery. In the total sample, operative time (minutes) ranged from 70 to 452 (M=206.12 64.08), with an average hospital stay of 2.09 days (1 day, range 1-5 days). Estimated blood loss (cc) ranged from 20 to 1000 (M=204.63 176.49). Uterine weight (g) ranged from 35 to 905 (M=188.52 153.32). Type of surgery (laparoscopic, robotic, vaginal) was unrelated to BMI, operative time, and length of hospital stay (all P >0.05). Type of surgery was related to estimated blood loss (P \0.05) and uterine weight (P \0.01). Conclusion: Robotically assisted hysterectomy for benign indications in patients with complex pathology is feasible, with low morbidity and short hospital stay. This study suggests that robotic assistance facilitates the use of a minimally invasive approach in high-risk patient populations.
607 Does Size Matter? The Effect of Uterine Weight on Robotic Assisted Total Laparoscopic Hysterectomy Outcomes Orady ME,1 Nawfal AK,1 Wegienka G.2 1Obstetrics and Gynecology/ Women’s Health Services, Henry Ford Medical Center, Detroit, Michigan; 2 Biostatistics and Research Epidemiology, Henry Ford Medical Center, Detroit, Michigan Study Objective: To determine whether benefits of robotic assisted total laparoscopic hysterectomy (RH) extend across the spectrum of uterine sizes. Design: Retrospective Cohort Study. Setting: Henry Ford Health System’s Community Teaching Hospitals. Patients: 110 patients who underwent RH for benign indications, at one of two hospitals, between January 2008 and February 2010. Intervention: Scheduled RH without concomitant urogynecologic procedures as the intention to treat. Measurements and Main Results: Patient demographics, height, weight, age, estimated blood loss (EBL), procedure duration, uterine weight, pathology, length of hospital stay (LOS) and Immediate and delayed complications were obtained from a detailed review of the Electronic Medical Record. Uterine weight ranged from 47-1020 grams (\250 grams, n=71; 250-500 grams, n=24; >500 grams, n=13). Most women had a LOS of 1 day (n=73, 66.4%), 25 women had a LOS of 2 days (22.7%), and 12 women had a LOS of greater than 2 days (10.9%). Overall, the uterine weight was highly correlated with procedure duration (Spearman correlation, r=0.51, p\0.001.). Median procedure duration increased from 154 minutes in the \ 250 gram group, to 201 minutes in the 250-500 gram group, to 294 minutes in the >500 gram group. Uterine weight was also moderately correlated with EBL (Spearman correlation r=0.29, p=0.003). Median EBL increased from 50 ml (\250 g group) to 100 ml in both the 250-500 gram and >500 gram groups. This was also reflected in the assessment of decrease in perioperative hemoglobin. Uterine weight was not correlated with LOS