Multicenter analysis comparing robotic, open, laparoscopic, and vaginal hysterectomies performed by high-volume surgeons for benign indications

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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 (> 250 g) 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). Conclusion When performed by gynecologic surgeons with relevant high-volume experience, robotic-assisted benign hysterectomy provided improved outcomes compared with abdominal, vaginal, and laparoscopic hysterectomy.

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Lim, P. C., Crane, J. T., English, E. J., Farnam, R. W., Garza, D. M., Winter, M. L., & Rozeboom, J. L. (2016). Multicenter analysis comparing robotic, open, laparoscopic, and vaginal hysterectomies performed by high-volume surgeons for benign indications. International Journal of Gynecology and Obstetrics, 133(3), 359–364. https://doi.org/10.1016/j.ijgo.2015.11.010

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