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Evaluation of the introduction of robotic technology on route of hysterectomy and complications in the first year of use

      Objective

      We sought to determine the differential rates and complications of hysterectomy type in the year prior to and following the introduction of robotic technology.

      Study Design

      This was a retrospective chart review of 461 hysterectomies performed from July 2007 through June 2008 (period 1) and July 2008 through June 2009 (period 2) at Virginia Commonwealth University Medical Center.

      Results

      In all, 199 vs 262 hysterectomies were performed in periods 1 and 2: open, 52.3% vs 43.1%; laparoscopic, 18.1% vs 8.0%; robotic, 2.5% vs 24.8%; and vaginal, 27.4% vs 24.1%, respectively. The increase in robotic hysterectomies in period 2 was associated only with a decline in laparoscopic hysterectomy (P < .0001). Major morbidity by route was 23.04% open, 11/1% vaginal, 7.02% laparoscopic, and 4.29% robotic (P < .0001).

      Conclusion

      Route of hysterectomy changed significantly after the introduction of robotic technology primarily due to a change in management of pelvic organ prolapse. Open hysterectomy was associated with significantly higher complication rates.

      Key words

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      References

        • Whiteman M.K.
        • Hillis S.D.
        • Jamieson D.J.
        • et al.
        Inpatient hysterectomy surveillance in the United States, 2000-2004.
        Am J Obstet Gynecol. 2008; 198: 34.e1-34.e7
        • Wu J.M.
        • Wechter M.E.
        • Geller E.J.
        • Nguyen T.V.
        • Visco A.G.
        Hysterectomy rates in the United States, 2003.
        Obstet Gynecol. 2007; 110: 1091-1095
        • Nieboer T.E.
        • Johnson N.
        • Lethaby A.
        • et al.
        Surgical approach to hysterectomy for benign gynecological disease.
        Cochrane Database Syst Rev. 2009; 3 (CD003677)
        • Garry R.
        • Fountain J.
        • Mason S.
        • et al.
        The eVALuate study: two parallel randomized trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy.
        BMJ. 2004; 328: 129
        • Johnson N.
        • Barlow D.
        • Lethaby A.
        • et al.
        Methods of hysterectomy: systematic review and meta-analysis of randomized controlled trials.
        BMJ. 2005; 330: 1478
        • Kovac S.R.
        Clinical opinion: guidelines for hysterectomy.
        Am J Obstet Gynecol. 2004; 191: 635-640
        • Tu F.F.
        • Beaumont J.L.
        • Senapati S.
        • Gordon T.E.
        Route of hysterectomy influence and teaching hospital status.
        Obstet Gynecol. 2009; 114: 73-78
        • Payne T.N.
        • Dauterive F.R.
        A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice.
        J Minim Invasive Gynecol. 2008; 15: 286-291
        • Pulliam S.J.
        • Berkowitz L.R.
        Smaller pieces of the hysterectomy pie: current challenges in resident surgical education.
        Obstet Gynecol. 2009; 113: 395-398
        • Association of Professors of Gynecology and Obstetrics
        Residency directory.
        (Accessed June 30, 2010)
        • Advincula A.P.
        • Wang K.
        Evolving role and current state of robotics in minimally invasive gynecologic surgery.
        J Minim Invasive Gynecol. 2009; 16: 291-301
        • Maher C.
        • Baessler K.
        • Glazener C.M.
        • Adams E.J.
        • Hagen S.
        Surgical management of pelvic organ prolapse in women.
        Cochrane Database Syst Rev. 2007; 3 (CD004014)
        • Dunn T.S.
        • Weaver A.
        • Wolf D.
        • Goodard W.
        Vaginal hysterectomies performed in a residency program: can we increase the number?.
        J Reprod Med. 2006; 51: 83-86
        • Kovac S.R.
        Transvaginal hysterectomy: rationale and surgical approach.
        Obstet Gynecol. 2004; 103: 1321-1325
        • Boggess J.F.
        • Gehrig P.A.
        • Cantrell L.
        • et al.
        Perioperative outcomes of robotically assisted hysterectomy for benign cases with complex pathology.
        Obstet Gynecol. 2009; 114: 585-593