The impact of robotics on the mode of benign hysterectomy and clinical outcomes

摘要

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.