The impact of robotics on the mode of benign hysterectomy and clinical outcomes.
BACKGROUND
The impact of robotics on benign hysterectomy surgical approach, clinical outcomes, and learning curve is still unclear.


METHODS
Review of abdominal, vaginal, laparoscopic, or robotic cases in 156 US hospitals in the Premier Research Database.


RESULTS
Of 289 875 hysterectomies, abdominal cases decreased from 2005-2010 (60-33%) and minimally invasive approaches increased (40-67%). Conversion rates were: 0.04% for vaginal, 2.5% for robotic, and 7.2% for laparoscopy (P < 0.001). Robotic surgery time was longest (3.4 h vs. 2.2 vaginal, 2.5 abdominal, 2.7 laparoscopy, P < 0.001). Robotic complication rate was lowest (14.8% vs. 16.2% vaginal, 18.6% laparoscopy, 28.9% abdominal, P < 0.001). Hospital stay was longer following abdominal surgery (3.5 days vs. 1.8 robotic, 1.9 vaginal, 1.8 laparoscopy, P < 0.001). Robotic surgery times and conversion and complication rates improved with experience (2.8 h, 2%, and 13.9%, respectively), even with increasing complexity.


CONCLUSIONS
Robotics was successfully incorporated without jeopardizing patient outcomes and increased the overall use of minimally invasive approaches.
Center for Fertility and Women's Health, Obstetrics and Gynecology, Hospital of Central Connecticut, New Britain, CT, USA.
Anthony A
AA
Luciano
Center for Fertility and Women's Health, Obstetrics and Gynecology, Hospital of Central Connecticut, New Britain, CT, USA.
Danielle E
DE
Luciano
InClin, Department of Biometrics, San Matteo, CA, USA.
Jessica
J
Gabbert
Intuitive Surgical, Department of Clinical Affairs, Sunnyvale, CA, USA.
Usha
U
Seshadri-Kreaden
D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D065287:Robotic Surgical Procedures / Q000379:methods*
abdominal; da Vinci surgical system; laparoscopy; learning curve; robotic-assisted hysterectomy; vaginal