ObjectivesAlthough robotic hysterectomy has been adopted by many institutions, associated complications compared to other hysterectomy routes have not been well studied. Our aim is to compare intraoperative complications by route of hysterectomy and complication trends before and after the introduction of robotic surgery.Materials and methodsThis is an ancillary analysis of a multicenter, retrospective cohort study with historical controls through the Fellows' Pelvic Research Network. Cases, hysterectomies for benign conditions, were collected from the year prior to introduction of the robot (pre-robot) and the year after introduction of the robot (post-robot). Representative annual case distributions for each institution was obtained by selecting 20 cases per month using stratified random sampling. Demographic information and peri-operative data were collected. Categorical variables were compared using chi-square or Fisher's exact test, continuous parametric variables using T-test or ANOVA and nonparametric data using Wilcoxon rank-sum or Kruskal-Wallis test. We adjusted for institutional data with Mantel-Haenszel test for categorical variables and ANOVA for continuous variables.ResultsOne thousand four hundred fifty-nine cases from 4 institutions were included. Demographic data are as follows, expressed as median (range): age 46 (19-86), BMI 28.4 (12.6-72.4), parity 2 (0-10). Most hysterectomies were performed by generalists in both pre-robotic and post-robotic periods, 75% and 80%, respectively. In the pre-robotic period, intra-operative complications did not differ significantly among approaches, ranging from 0% (total laparoscopic) to 14% (abdominal supracervical). No significant differences in post-operative complications were noted in this period among approaches (p > 0.05). In the post-robotic period, intraoperative complications were higher for total abdominal than laparoscopic/robotic hysterectomy (17.5% vs. 0%, respectively, p < 0.05). For postoperative complications, total abdominal hysterectomy had the highest number of complications (10.3%) and supracervical hysterectomy (laparoscopic or abdominal) had the lowest (0%). Comparing pre-robotic and post-robotic periods, the proportion of intraoperative complications did not differ (5.6% pre-robot vs. 6.1% post-robot, p > 0.05). However, when analyzed by injury type, higher rate of ureteral injury was seen in the post-robotic (11.4%, n = 5) compared to the pre-robotic period (2.4%, n = 1, p = 0.05).ConclusionIn the pre-robotic period, intraoperative and postoperative complications rates were similar among different hysterectomy approaches. In the post-robotic period, there were higher rates of intraoperative complications in the open abdominal approaches (abdominal total and supracervical hysterectomy) compared to the minimally invasive approaches (laparoscopic and robotic).TablePeri-operative complications by hysterectomy typeTotal VaginalTotal AbdominalAbdominal SupracervicalLaparoscopic Assisted VaginalTotal LaparoscopicLaparoscopic SupracervicalTotal RoboticRobotic Supracervicalp valuePre-Robot n (%)312 (42.3)165 (22.4)43 (5.8)153 (20.7)12 (1.6)53 (7.2)Intraoperative Complications n (%)13 (4.2)14 (8.5)6 (14.0)7 (4.6)0 (0.0)1 (1.9)0.06Post-operative Complications n (%)12 (3.8)11 (6.7)2 (4.7)4 (2.7)0 (0.0)0 (0.0)0.30Post-Robot n (%)216 (30.0)126 (17.5)16 (2.2)81 (11.2)84 (11.7)33 (4.6)130 (18.0)35 (4.9)Intraoperative Complications n (%)6 (2.8)22 (17.5)2 (12.5)4 (4.9)5 (6.0)0 (0.0)5 (3.8)0 (0.0)0.0001Post-operative Complications n (%)3 (1.4)13 (10.3)0 (0.0)2 (2.5)1 (1.2)0 (0.0)2 (1.5)2 (5.7)0.002 Open table in a new tab ObjectivesAlthough robotic hysterectomy has been adopted by many institutions, associated complications compared to other hysterectomy routes have not been well studied. Our aim is to compare intraoperative complications by route of hysterectomy and complication trends before and after the introduction of robotic surgery. Although robotic hysterectomy has been adopted by many institutions, associated complications compared to other hysterectomy routes have not been well studied. Our aim is to compare intraoperative complications by route of hysterectomy and complication trends before and after the introduction of robotic surgery. Materials and methodsThis is an ancillary analysis of a multicenter, retrospective cohort study with historical controls through the Fellows' Pelvic Research Network. Cases, hysterectomies for benign conditions, were collected from the year prior to introduction of the robot (pre-robot) and the year after introduction of the robot (post-robot). Representative annual case distributions for each institution was obtained by selecting 20 cases per month using stratified random sampling. Demographic information and peri-operative data were collected. Categorical variables were compared using chi-square or Fisher's exact test, continuous parametric variables using T-test or ANOVA and nonparametric data using Wilcoxon rank-sum or Kruskal-Wallis test. We adjusted for institutional data with Mantel-Haenszel test for categorical variables and ANOVA for continuous variables. This is an ancillary analysis of a multicenter, retrospective cohort study with historical controls through the Fellows' Pelvic Research Network. Cases, hysterectomies for benign conditions, were collected from the year prior to introduction of the robot (pre-robot) and the year after introduction of the robot (post-robot). Representative annual case distributions for each institution was obtained by selecting 20 cases per month using stratified random sampling. Demographic information and peri-operative data were collected. Categorical variables were compared using chi-square or Fisher's exact test, continuous parametric variables using T-test or ANOVA and nonparametric data using Wilcoxon rank-sum or Kruskal-Wallis test. We adjusted for institutional data with Mantel-Haenszel test for categorical variables and ANOVA for continuous variables. ResultsOne thousand four hundred fifty-nine cases from 4 institutions were included. Demographic data are as follows, expressed as median (range): age 46 (19-86), BMI 28.4 (12.6-72.4), parity 2 (0-10). Most hysterectomies were performed by generalists in both pre-robotic and post-robotic periods, 75% and 80%, respectively. In the pre-robotic period, intra-operative complications did not differ significantly among approaches, ranging from 0% (total laparoscopic) to 14% (abdominal supracervical). No significant differences in post-operative complications were noted in this period among approaches (p > 0.05). In the post-robotic period, intraoperative complications were higher for total abdominal than laparoscopic/robotic hysterectomy (17.5% vs. 0%, respectively, p < 0.05). For postoperative complications, total abdominal hysterectomy had the highest number of complications (10.3%) and supracervical hysterectomy (laparoscopic or abdominal) had the lowest (0%). Comparing pre-robotic and post-robotic periods, the proportion of intraoperative complications did not differ (5.6% pre-robot vs. 6.1% post-robot, p > 0.05). However, when analyzed by injury type, higher rate of ureteral injury was seen in the post-robotic (11.4%, n = 5) compared to the pre-robotic period (2.4%, n = 1, p = 0.05). One thousand four hundred fifty-nine cases from 4 institutions were included. Demographic data are as follows, expressed as median (range): age 46 (19-86), BMI 28.4 (12.6-72.4), parity 2 (0-10). Most hysterectomies were performed by generalists in both pre-robotic and post-robotic periods, 75% and 80%, respectively. In the pre-robotic period, intra-operative complications did not differ significantly among approaches, ranging from 0% (total laparoscopic) to 14% (abdominal supracervical). No significant differences in post-operative complications were noted in this period among approaches (p > 0.05). In the post-robotic period, intraoperative complications were higher for total abdominal than laparoscopic/robotic hysterectomy (17.5% vs. 0%, respectively, p < 0.05). For postoperative complications, total abdominal hysterectomy had the highest number of complications (10.3%) and supracervical hysterectomy (laparoscopic or abdominal) had the lowest (0%). Comparing pre-robotic and post-robotic periods, the proportion of intraoperative complications did not differ (5.6% pre-robot vs. 6.1% post-robot, p > 0.05). However, when analyzed by injury type, higher rate of ureteral injury was seen in the post-robotic (11.4%, n = 5) compared to the pre-robotic period (2.4%, n = 1, p = 0.05). ConclusionIn the pre-robotic period, intraoperative and postoperative complications rates were similar among different hysterectomy approaches. In the post-robotic period, there were higher rates of intraoperative complications in the open abdominal approaches (abdominal total and supracervical hysterectomy) compared to the minimally invasive approaches (laparoscopic and robotic).TablePeri-operative complications by hysterectomy typeTotal VaginalTotal AbdominalAbdominal SupracervicalLaparoscopic Assisted VaginalTotal LaparoscopicLaparoscopic SupracervicalTotal RoboticRobotic Supracervicalp valuePre-Robot n (%)312 (42.3)165 (22.4)43 (5.8)153 (20.7)12 (1.6)53 (7.2)Intraoperative Complications n (%)13 (4.2)14 (8.5)6 (14.0)7 (4.6)0 (0.0)1 (1.9)0.06Post-operative Complications n (%)12 (3.8)11 (6.7)2 (4.7)4 (2.7)0 (0.0)0 (0.0)0.30Post-Robot n (%)216 (30.0)126 (17.5)16 (2.2)81 (11.2)84 (11.7)33 (4.6)130 (18.0)35 (4.9)Intraoperative Complications n (%)6 (2.8)22 (17.5)2 (12.5)4 (4.9)5 (6.0)0 (0.0)5 (3.8)0 (0.0)0.0001Post-operative Complications n (%)3 (1.4)13 (10.3)0 (0.0)2 (2.5)1 (1.2)0 (0.0)2 (1.5)2 (5.7)0.002 Open table in a new tab In the pre-robotic period, intraoperative and postoperative complications rates were similar among different hysterectomy approaches. In the post-robotic period, there were higher rates of intraoperative complications in the open abdominal approaches (abdominal total and supracervical hysterectomy) compared to the minimally invasive approaches (laparoscopic and robotic).