Blood loss from robotic assisted hysterectomy

Objective: The aim of this research was to study the change in hemoglobin (Hb) observed in patients who undergo robotic assisted hysterectomy (RAH), compared to those who undergo hysterectomy via laparotomy. Design: This was a retrospective cohort study. Materials and Methods: The demographics and clinical characteristics of 90 patients who underwent RAH were studied and compared empirically to 180 patients who underwent total abdominal hysterectomy (TAH) to evaluate the postoperative drop in Hb as it related to estimated blood loss (EBL). Results: The EBL was higher in patients who underwent TAH, compared to RAH (median [interquartile range, IQR]: 300 [150, 500] mL versus 100 [50, 150] mL; p < 0.0001). Of the patients undergoing RAH 1 (1%) received a blood transfusion, compared to 17 (9%) of the 180 patients who underwent laparotomy (median [IQR]: 2 [2, 3] units). The median (IQR) preoperative Hb was 13.1 g/dL (12.3-14.0 g/dL) for patients who underwent RAH and 12.2 g/dL (10.8-13.3 g/dL) for those who underwent TAH. When patients who received blood transfusions were excluded from the analysis, the median (IQR) decrease in Hb was 2.2 g/dL (1.4-3.1 g/dL) for RAH versus 1.8 g/ dL (1.2-2.3 g/dL) for TAH ( p = 0.008). Conclusions: Though blood transfusion was more common in patients who underwent TAH, the decrease in Hb after RAH was more than expected according to the EBL. This might have been due to occult blood loss that occurred after the intra-abdominal pressure normalized following surgery.