{"paper_id":"21627c8b-834d-4683-aba4-61cadba343c0","body_text":"Abstract\nThe objective of this study was to determine the trends in surgical approach to hysterectomy over the last decade and compare perioperative outcomes and complications. This retrospective cohort study used clinical registry data from the Michigan Hospitals that participated in Michigan Surgical Quality Collaborative (MSQC) from January 1st, 2010 through December 30th, 2020. A multigroup time series analysis was performed to determine how surgical approach to hysterectomy [open/TAH, laparoscopic (TLH/LAVH), and robotic-assisted (RA)] has changed over the last decade. Abnormal uterine bleeding, uterine fibroids, chronic pelvic pain, pelvic organ prolapse, endometriosis, pelvic mass, and endometrial cancer were the most common indications for hysterectomy. The open approach to hysterectomy declined from 32.6 to 16.9%, a 1.9-fold decrease, with an average decline of 1.6% per year (95% CI − 2.3 to − 0.9%). Laparoscopic-assisted hysterectomies decreased from 27.2 to 23.8%, a 1.5-fold decrease, with an average decrease of 0.1% per year (95% CI − 0.7 to 0.6%). Finally, the robotic-assisted approach increased from 38.3 to 49.3%, a 1.25-fold increase, with an average of 1.1% per year (95% CI 0.5 to 1.7%). For malignant cases, open procedures decreased from 71.4 to 26.6%, a 2.7-fold decrease, while RA-hysterectomy increased from 19.0 to 58.7%, a 3.1-fold increase. After controlling for the confounding variables age, race, and gynecologic malignancy, RA hysterectomy was found to have the lowest rate of complications when compared to the vaginal, laparoscopic and open approaches. Finally, after controlling for uterine weight, black patients were twice as likely to undergo an open hysterectomy compared to white patients.\nSimilar content being viewed by others\nAvailability of data and material\nUpon Request.\nReferences\nAarts JWM, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BJ, Kluivers KB (2015) Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003677.pub5\nMatteson, KA, Butts, SF (2017) Committee Opinion No 701: choosing the route of hysterectomy for benign disease. Obstet Gynecol 129(6):e155–e159.\nCarbonnel M, Moawad GN, Tarazi MM, Revaux A, Kennel T, Favre-Inhofer A, Ayoubi JM (2021) Robotic hysterectomy for benign indications: what have we learned from a decade? JSLS. 25(1):e2020.00091. https://doi.org/10.4293/JSLS.2020.00091\nSwenson CW, Kamdar NS, Harris JA, Uppal S, Campbell DA Jr, Morgan DM (2016) Comparison of robotic and other minimally invasive routes of hysterectomy for benign indications. Am J Obstet Gynecol. 215(5):650.e1-650.e8. https://doi.org/10.1016/j.ajog.2016.06.027\nSettnes A, Topsoee MF, Moeller C, Dueholm M, Kopp TI, Norrbom C, Rasmussen SC, Froeslev PA, Joergensen A, Dreisler E, Gimbel H (2020) Reduced complications following implementation of laparoscopic hysterectomy: a Danish population-based cohort study of minimally invasive benign gynecologic surgery between 2004 and 2018. J Minim Invasive Gynecol 27(6):1344-1353.e3. https://doi.org/10.1016/j.jmig.2019.11.005\nBaracy MG Jr, Martinez M, Hagglund K, Afzal F, Kulkarni S, Corey L, Aslam MF (2022) Minimally invasive hysterectomy for benign indications-surgical volume matters: a retrospective cohort study comparing complications of robotic-assisted and conventional laparoscopic hysterectomies. J Robot Surg. https://doi.org/10.1007/s11701-021-01340-2\nGiep BN, Giep HN, Hubert HB (2010) Comparison of minimally invasive surgical approaches for hysterectomy at a community hospital: robotic-assisted laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy and laparoscopic supracervical hysterectomy. J Robot Surg 4(3):167–175\nRoh HF, Nam SH, Kim JM (2018) Robot-assisted laparoscopic surgery versus conventional laparoscopic surgery in randomized controlled trials: a systematic review and meta-analysis. PLoS ONE 13(1):e0191628\nvan Weelden WJ, Gordon BBM, Roovers EA, Kraayenbrink AA, Aalders CIM, Hartog F et al (2017) Perioperative surgical outcome of conventional and robot-assisted total laparoscopic hysterectomy. Gynecol Surg. 14(1):5\nSoto E, Lo Y, Friedman K, Soto C, Nezhat F, Chuang L et al (2011) Total laparoscopic hysterectomy versus da Vinci robotic hysterectomy: is using the robot beneficial? J Gynecol Oncol 22(4):253–259\nAlbright BB, Witte T, Tofte AN, Chou J, Black JD, Desai VB, Erekson EA (2016) Robotic versus laparoscopic hysterectomy for benign disease: a systematic review and meta-analysis of randomized trials. J Minim Invasive Gynecol 23(1):18–27. https://doi.org/10.1016/j.jmig.2015.08.003\nSarlos D, Kots L, Stevanovic N, von Felten S, Schär G (2012) Robotic compared with conventional laparoscopic hysterectomy: a randomized controlled trial. Obstet Gynecol 120(3):604–611. https://doi.org/10.1097/AOG.0b013e318265b61a\nParaiso MF, Ridgeway B, Park AJ, Jelovsek JE, Barber MD, Falcone T, Einarsson JI (2013) A randomized trial comparing conventional and robotically assisted total laparoscopic hysterectomy. Am J Obstet Gynecol 208(5):368.e1–7. https://doi.org/10.1016/j.ajog.2013.02.008\nSheetz KH, Norton EC, Dimick JB, Regenbogen SE (2020) Perioperative outcomes and trends in the use of robotic colectomy for medicare beneficiaries from 2010 through 2016. JAMA Surg 155(1):41–49. https://doi.org/10.1001/jamasurg.2019.4083\nMelamed A, Margul DJ, Chen L, Keating NL, Del Carmen MG, Yang J, Seagle BL, Alexander A, Barber EL, Rice LW, Wright JD, Kocherginsky M, Shahabi S, Rauh-Hain JA (2018) Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. N Engl J Med. 379(20):1905–1914. https://doi.org/10.1056/NEJMoa1804923\nNitecki R, Ramirez PT, Frumovitz M, Krause KJ, Tergas AI, Wright JD, Rauh-Hain JA, Melamed A (2020) Survival after minimally invasive vs open radical hysterectomy for early-stage cervical cancer: a systematic review and meta-analysis. JAMA Oncol 6(7):1019–1027. https://doi.org/10.1001/jamaoncol.2020.1694\nRamirez PT, Frumovitz M, Pareja R, Lopez A, Vieira M, Ribeiro R, Buda A, Yan X, Shuzhong Y, Chetty N, Isla D, Tamura M, Zhu T, Robledo KP, Gebski V, Asher R, Behan V, Nicklin JL, Coleman RL, Obermair A (2018) Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med 379(20):1895–1904. https://doi.org/10.1056/NEJMoa1806395\nNie JC, Yan AQ, Liu XS (2017) Robotic-assisted radical hysterectomy results in better surgical outcomes compared with the traditional laparoscopic radical hysterectomy for the treatment of cervical cancer. Int J Gynecol Cancer 27(9):1990–1999. https://doi.org/10.1097/IGC.0000000000001101\nChen L, Liu LP, Wen N, Qiao X, Meng YG (2019) Comparative analysis of robotic vs laparoscopic radical hysterectomy for cervical cancer. World J Clin Cases 7(20):3185–3193. https://doi.org/10.12998/wjcc.v7.i20.3185\nHan L, Yan P, Yao L, Liu R, Shao R, Liu J, Chen X, Wang L, Yang K, Guo T, Wang H (2019) Safety and effectiveness of robotic hysterectomy versus conventional laparoscopic hysterectomy in patients with cervical cancer in China. Arch Gynecol Obstet 300(1):153–160. https://doi.org/10.1007/s00404-019-05148-2\nJørgensen SL, Mogensen O, Wu C et al (2019) Nationwide introduction of minimally invasive robotic surgery for early-stage endometrial cancer and its association with severe complications. JAMA Surg 154(6):530–538. https://doi.org/10.1001/jamasurg.2018.5840\nMäenpää MM, Nieminen K, Tomás EI, Laurila M, Luukkaala TH, Mäenpää JU (2016) Robotic-assisted vs traditional laparoscopic surgery for endometrial cancer: a randomized controlled trial. Am J Obstet Gynecol 215(5):588.e1-588.e7. https://doi.org/10.1016/j.ajog.2016.06.005\nWang J, Li X, Wu H, Zhang Y, Wang F (2020) A meta-analysis of robotic surgery in endometrial cancer: comparison with laparoscopy and laparotomy. Dis Markers 21(2020):2503753. https://doi.org/10.1155/2020/2503753\nInd T, Laios A, Hacking M, Nobbenhuis M (2017) A comparison of operative outcomes between standard and robotic laparoscopic surgery for endometrial cancer: a systematic review and meta-analysis. Int J Med Robot. 13(4):e1851. https://doi.org/10.1002/rcs.1851\nAlexander AL, Strohl AE, Rieder S, Holl J, Barber EL (2019) Examining disparities in route of surgery and postoperative complications in black race and hysterectomy. Obstet Gynecol 133(1):6–12. https://doi.org/10.1097/AOG.0000000000002990\nMarshall LM, Spiegelman D, Barbieri RL, Goldman MB, Manson JE, Colditz GA, Willett WC, Hunter DJ (1997) Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol 90(6):967–973. https://doi.org/10.1016/s0029-7844(97)00534-6\nWechter ME, Stewart EA, Myers ER, Kho RM, Wu JM (2011) Leiomyoma-related hospitalization and surgery: prevalence and predicted growth based on population trends. Am J Obstet Gynecol. 205(5):492.e1–5. https://doi.org/10.1016/j.ajog.2011.07.008\nLaughlin-Tommaso SK, Jacoby VL, Myers ER (2017) Disparities in fibroid incidence, prognosis, and management. Obstet Gynecol Clin N Am 44(1):81–94. https://doi.org/10.1016/j.ogc.2016.11.007\nAcknowledgements\nThe authors of this manuscript would like to thank the wonderful staff at the Michigan Surgical Quality Collaborative (MSQC), especially Heather Marshall, Kushal Singh, and Alexander Hallway for their help retrieving data and their guidance in the production of this manuscript.\nFunding\nNone.\nAuthor information\nAuthors and Affiliations\nContributions\nMB conceived of the idea, designed the protocol and wrote the manuscript. MB, AK, and BF organized operative diagnoses, CPT codes, ICD-9 and ICD-10 codes and ensured integrity of codification. KH verified the protocol was methodologically sound and analyzed the data. LC and MA was integral in the design and execution of the project. All authors discussed the final results and contributed to the final manuscript.\nCorresponding author\nEthics declarations\nConflict of interest\nThe author declares that they have no conflict of interest.\nEthics approval\nThis study was given the determination of not human subjects research by the Ascension St. John Institutional Review Boards (IRB) on 03/02/2022 (Reference #1876078).\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nSupplementary Information\nBelow is the link to the electronic supplementary material.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nBaracy, M.G., Kerl, A., Hagglund, K. et al. Trends in surgical approach to hysterectomy and perioperative outcomes in Michigan hospitals from 2010 through 2020. J Robotic Surg 17, 2211–2220 (2023). https://doi.org/10.1007/s11701-023-01631-w\nReceived:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s11701-023-01631-w","source_license":"CC0","license_restricted":false}