Optimal tissue retrieval in robot-assisted total laparoscopic hysterectomy.

To investigate appropriate tissue retrieval methods following robot-assisted total laparoscopic hysterectomy (RA-TLH) based on various factors. This study included 381 patients who underwent RA-TLH for benign uterine tumors. We analyzed the optimal tissue weight retrieved and influencing factors for three approaches: transvaginal retrieval (TV), transvaginal retrieval using a Wound Retractor (WR), and small incision retrieval (SI). We also examined appropriate retrieval times and reasonable tissue weights. Tissue retrieval was performed in 123, 143, and 50 cases for TV, WR, and SI, respectively. WR exhibited shorter retrieval times than TV for weights of ≥ 70 g, but longer than SI for weights of ≥ 456 g. In the analyses of nonvaginal delivery women (NVDW) and vaginal delivery women (VDW), the retrieval time difference between TV/WR and SI increased with increasing weight. This increase was most pronounced for TV in NVDW. The predicted retrieved weight at 30 min was 385 g for TV in NVDW, 608 g in VDW, 744 g for WR in NVDW, 792 g in VDW, and 1,091 g for SI. Complications were observed in 12 cases; one case was a Clavien–Dindo classification grade IIIb, and the others were grade II or lower. The use of the Wound Retractor for transvaginal retrieval is beneficial, regardless of a vaginal delivery history. This study revealed that an appropriate retrieved weight is around 770 g when the retrieval time is set to 30 min, and that retrieval via a small incision is appropriate for weights exceeding 1000 g.