title: Impact of robotic technology on hysterectomy route and associated implications for resident education.
abstract: We sought to compare the proportion of benign hysterectomies performed vaginally and the mean number of hysterectomies with resident involvement by route before and after robot implementation.
  
  
  
  This multicenter, retrospective cohort study using nonsynchronous controls was conducted through the Society of Gynecologic Surgeons Fellows' Pelvic Research Network. The route of hysterectomy for benign disease was compared for 1-year periods before (prerobot) and after (postrobot) robotic introduction at 4 academic institutions. We reviewed medical records and recorded patient demographics, hysterectomy approach, preoperative and postoperative diagnosis, and resident involvement.
  
  
  
  In all, 1440 hysterectomies were included: 732 in the prerobot group and 708 in the postrobot group. Median age was 46 years and mean body mass index was 29.5 (standard deviation, 6.9). The proportion of hysterectomies performed via the vaginal route decreased from 42.5% prerobot to 30.5% postrobot (P < .0001) and via the abdominal route from 22.1% prerobot to 16.5% postrobot (P = .001). The proportion of hysterectomies performed laparoscopically increased from 1.6% prerobot to 11.9% postrobot (P < .0001). At a mean of 2.3 years after introduction of the robot into an institution, hysterectomies performed using robotic assistance accounted for 23.3% of hysterectomies for benign disease. Mean uterine weight was similar in the prerobot and postrobot groups. Resident involvement in all hysterectomies done via all routes other than robotic increased from 81.0% prerobot to 88.6% postrobot; however, residents were involved in only 58.9% of robotic hysterectomies.
  
  
  
  The proportion of hysterectomies performed vaginally has significantly decreased since the adoption of robotic technology at institutions included in this study. The proportion of hysterectomies with resident involvement is lower with a robotic approach than any other route.
authors: Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI. Electronic address: peterjeppson@gmail.com.
authors: Peter C
authors: PC
authors: Jeppson
authors: Department of Obstetrics and Gynecology, Mount Sinai School of Medicine, New York, NY.
authors: Salma
authors: S
authors: Rahimi
authors: Department of Obstetrics and Gynecology, Emory University School of Medicine, Atlanta, GA.
authors: Leda
authors: L
authors: Gattoc
authors: Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH.
authors: Lauren B
authors: LB
authors: Westermann
authors: Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM.
authors: Sara
authors: S
authors: Cichowski
authors: Division of Research, Women and Infants Hospital of Rhode Island, Providence, RI.
authors: Christina
authors: C
authors: Raker
authors: Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL.
authors: Emily Elise Weber
authors: EEW
authors: LeBrun
authors: Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI.
authors: Vivian W
authors: VW
authors: Sung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000193:education / Q000379:methods*; D007045:Hysterectomy, Vaginal / Q000193:education / Q000379:methods*; D007396:Internship and Residency / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000193:education / Q000379:methods*; D014591:Uterine Diseases / Q000601:surgery*; D055815:Young Adult
keywords: resident education; robotic hysterectomy