Adoption of robot-assisted surgery for hysterectomy in France: a nationwide analysis of surgical routes and length of hospital stay (2020-2024)

Background: Robot-assisted hysterectomy (RAH) has been progressively introduced in gynecologic surgery, yet nationwide data describing its uptake and early efficiency outcomes remain limited. We described trends in surgical route for hysterectomy within France and evaluate the length of hospital stay (LoS) according to surgical route and center expertise in robot-assisted surgery (RAS). Methods: All total hysterectomies (excluding vaginal) performed in France between January 2020 and December 2024 were identified from the national Programme de Médicalisation des Systèmes d’Informations (PMSI) registry. Procedures were categorized as open, laparoscopic hysterectomy (LH), or RAH and stratified by indication (endometriosis, other benign conditions, malignancy) and by center expertise in RAS, including multidisciplinary RAS centers. Primary outcomes were surgical volumes by approach and LoS. Results: Among 196,050 hysterectomies, LH remained the predominant approach; nevertheless, the proportion of RAH increased steadily across all indications over time, mainly at the expense of open surgery. This increase was more pronounced in high-volume and multidisciplinary RAS centers. Across indications, LoS was consistently shorter after minimally invasive surgery than after open hysterectomy. LoS following RAH was comparable to LH and decreased progressively over time. In experienced and multidisciplinary RAS centers, RAH was associated with the lowest LoS for benign indications. Conclusions: These nationwide, real-world findings show that RAH is increasingly being integrated into minimally invasive hysterectomy pathways within France, with LoS comparable to laparoscopy and shorter than open surgery. Our results support the role of RAS expertise and multidisciplinary organization in optimizing early clinical and operational outcomes during the adoption of gynecologic RAS. Similar content being viewed by others Data availability The data used in this study may be made available upon reasonable request to the corresponding author.

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Editorial support was provided by Deborah Nock (Medical WriteAway, Norwich, UK). Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript, apart from financial support from Intuitive Surgical Sarl to cover the services provided by the medical writer. Author information Authors and Affiliations Contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Salma Touleimat and Sofiane Bendifallah. The draft manuscript was written via contributions from all authors, who continued to review the manuscript until ready for submission. All authors read and approved the final manuscript. Corresponding author Ethics declarations Competing interests Elise Furet, Céline Chauleur, Enrica Bentivegna, Pablo Esteves, Martin Koskas, and Sofiane Bendifallah are proctors for Intuitive. The remaining authors have no relevant financial or non-financial interests to disclose. Patient consent All patients signed informed consent to authorize prospective data collection in the nationwide French “Programme de Médicalisation des Systèmes d’Informations” (PMSI) registry and for retrospective data analysis. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Below is the link to the electronic supplementary material. Rights and permissions Springer 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. About this article Cite this article Touleimat, S., Furet, E., Chauleur, C. et al. Adoption of robot-assisted surgery for hysterectomy in France: a nationwide analysis of surgical routes and length of hospital stay (2020–2024). J Robotic Surg 20, 490 (2026). https://doi.org/10.1007/s11701-026-03458-7 Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s11701-026-03458-7