title: Multicenter analysis comparing robotic, open, laparoscopic, and vaginal hysterectomies performed by high-volume surgeons for benign indications.
abstract: OBJECTIVE
  To compare perioperative outcomes between robotic-assisted benign hysterectomies and abdominal, vaginal, and laparoscopic hysterectomies when performed by high-volume surgeons.
  
  
  METHODS
  A multicenter data analysis compared 30-day outcomes from consecutive robotic-assisted hysterectomies performed by high-volume surgeons (≥60 prior procedures) at nine centers with records retrieved from the Premier Perspective database for abdominal, vaginal, and laparoscopic hysterectomies performed by high-volume gynecologic surgeons. Data on benign hysterectomy disorders from January 1, 2012 to September 30, 2013 were included.
  
  
  RESULTS
  Data from 2300 robotic-assisted, 9745 abdominal, 8121 vaginal, and 11 952 laparoscopic hysterectomies were included. The robotic-assisted patient cohort had a significantly higher rate of adhesive disease compared with the vaginal (P<0.001) and laparoscopic cohorts (P<0.001), a significantly higher rate of morbid obesity than the vaginal (P<0.001) or laparoscopic cohorts (P<0.001), and a significantly higher rate of large uteri (>250g) than the abdominal (P<0.001), vaginal (P<0.001), or laparoscopic cohorts (P=0.017). The robotic-assisted cohort experienced significantly fewer intraoperative complications than the abdominal (P<0.001) and vaginal cohorts (P<0.001), and experienced significantly fewer postoperative complications compared with all the comparator cohorts (P<0.001).
  
  
  CONCLUSIONS
  When performed by gynecologic surgeons with relevant high-volume experience, robotic-assisted benign hysterectomy provided improved outcomes compared with abdominal, vaginal, and laparoscopic hysterectomy.
authors.affiliation: The Center of Hope, Renown Regional Medical Center, Reno, NV, USA. Electronic address: pclimgyo@gmail.com.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Lim
authors.affiliation: Banner Health Clinic, Loveland, CO, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Crane
authors.affiliation: OB-GYN West, Eden Prarie, MN, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: English
authors.affiliation: Texas Urogynecology and Laser Surgery Center, El Paso, TX, USA.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Farnam
authors.affiliation: Renaissance Women's Group, Austin, TX, USA.
authors.forename: Devin M
authors.initials: DM
authors.lastname: Garza
authors.affiliation: Orange Coast Women's Medical Group, Laguna Hills, CA, USA.
authors.forename: Marc L
authors.initials: ML
authors.lastname: Winter
authors.affiliation: OB-GYN Associates, Cedar Rapids, IA, USA.
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Rozeboom
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007431:Intraoperative Complications / Q000453:epidemiology*; D010535:Laparoscopy; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome; D014481:United States; D014621:Vagina / Q000601:surgery
keywords: Abdominal hysterectomy; Laparoscopic hysterectomy; Premier database; Robotic-assisted hysterectomy; Vaginal hysterectomy; da Vinci