title: Effect of robotic surgery on hysterectomy trends: implications for resident education.
abstract: OBJECTIVE
  To compare the surgical approach used for hysterectomy at 2 teaching hospitals before and after introduction of the robotic surgical system.
  
  
  METHODS
  Retrospective cohort study (Canadian Task Force classification II-3).
  
  
  METHODS
  Two gynecologic training sites at the University of Hawaii.
  
  
  METHODS
  Women who underwent hysterectomy between January 1, 2005, and December 31, 2011.
  
  
  RESULTS
  ICD-9 procedural codes were used to identify hysterectomies performed between January 1, 2005, and December 31, 2011. Hysterectomies were categorized according to surgical approach: abdominal, vaginal, laparoscopic-assisted vaginal/total laparoscopic, and robotic. Each hysterectomy was also categorized according to primary preoperative diagnosis as general gynecology, gynecologic oncology, and urogynecology. The rates and numbers of hysterectomies performed during 2005-2006 (2 years before acquisition of the robot), 2007-2008 (first 2 years with the robot), and 2009-2011 (3-5 years after acquiring the robot) were compared using χ(2) tests and analysis of variance. The numbers of hysterectomies reported in resident case logs were also collected and compared. A total of 5894 hysterectomies were performed between 2005 and 2011. The total number of hysterectomies performed at Hospital A, which acquired the robotic surgical system, increased over time (p = .04) but remained stable at Hospital B, which did not acquire the robotic surgical system. At Hospital A, the number of robotic hysterectomies increased as the number of abdominal hysterectomies decreased (p < .001), a trend consistent across all diagnostic categories. The number of vaginal and laparoscopic hysterectomies remained stable. Resident case logs also reflected a decrease in the number of abdominal hysterectomies (p = .002) and an increase in the number of combined laparoscopic/robotic hysterectomies (p < .001) performed. The total number of hysterectomies performed by residents was unchanged.
  
  
  CONCLUSIONS
  Introduction of the robotic surgical system was associated with significant changes in the numbers and types of hysterectomies performed in both general and subspecialty gynecology. Although abdominal hysterectomies decreased as robotic hysterectomies increased, other hysterectomies did not. These trends mirror reported resident surgical experience and have implications for resident education.
authors.affiliation: Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu. Electronic address: kyamasat@hawaii.edu.
authors.forename: Kelly
authors.initials: K
authors.lastname: Yamasato
authors.affiliation: Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu.
authors.forename: Duffy
authors.initials: D
authors.lastname: Casey
authors.affiliation: Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu.
authors.forename: Bliss
authors.initials: B
authors.lastname: Kaneshiro
authors.affiliation: Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu.
authors.forename: Mark
authors.initials: M
authors.lastname: Hiraoka
mesh_terms: D000328:Adult; D002170:Canada; D015331:Cohort Studies; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery; D006176:Gynecology / Q000193:education; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data / Q000639:trends*; D007396:Internship and Residency; D010535:Laparoscopy / Q000639:trends; D008875:Middle Aged; D010820:Physicians; D012189:Retrospective Studies; D012371:Robotics / Q000706:statistics & numerical data / Q000639:trends*
keywords: Hysterectomy; Resident education; Robotic; Surgical training