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 (> 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.