J Robot Surg. 2026 May 12;20(1):484. doi: 10.1007/s11701-026-03423-4.
ABSTRACT
Aims to clarify the role of robotic-assisted system in hysterectomies for benign and malignant conditions and offer strong evidence for choosing the best surgical approach. A retrospective study enrolled 4821 hysterectomy and radical hysterectomy cases post-robotic surgery introduction. Cases were categorized by disease status (benign or malignant) and surgical approach. Time-series analysis assessed annual trends in surgical approaches, and propensity score matching compared surgical outcomes to minimize bias. Over the past decade at our center, the use of robotic surgery for all benign and malignant hysterectomies increased from 6.1% to 38.2%. Among patients with cervical cancer, the robotic surgery utilization rate increased from 12.5% to 55.9% by 2024, and establishing this technique as a leading approach for cervical cancer alongside open surgery. While both robotic and laparoscopic approaches yield similar operative and complication outcomes, robotic surgery incurs an additional cost of 2.79 (thousand USD) for benign hysterectomies. However, for endometrial carcinoma with pelvic lymph node dissection, robotic surgery reduced operative time by 48.5 min (P < 0.05). In radical hysterectomy for cervical cancer, the robotic approach not only reduced operative time by 30 min (P < 0.05), but also significantly decreased intraoperative transfusions (2.5% vs 14.3%, P < 0.0001), unplanned reoperations (0.7% vs 3.9%, P = 0.021), surgical complications (25% vs. 40%, P = 0.0002), and major complications (3.6% vs 12.5%, P = 0.0001) compared to open surgery. Robotic-assisted systems are frequently used for hysterectomies, offering no benefit over laparoscopy for benign cases and being more costly. However, they shorten operative time in procedures involving pelvic lymph node dissection. Furthermore, in complex radical hysterectomies, they not only decrease operative time but also improve surgical outcomes, such as reducing blood transfusions, reoperations, and complications.
PMID:42115535 | DOI:10.1007/s11701-026-03423-4
