Trends and comparative study of robotic-assisted benign hysterectomy among morbidly obese patients in united States

BACKGROUND: To analyze trends in surgical approach stratified by Body Mass Index (BMI) among women undergoing hysterectomy for benign indications in the United States and to compare clinical outcomes in morbidly obese patients (BMI > 40 kg/m2) undergoing minimally invasive surgery (laparoscopic vs. robot-assisted). METHODS: This was a retrospective cohort study using the Premier Healthcare Database to identify patients who underwent elective benign hysterectomy between 2013 and 2020. Patients were identified using ICD-9, ICD-10, and CPT codes. A 1:1 propensity score-matched analysis was completed to compare robotic versus laparoscopic approaches among morbidly obese patients between 2017 and 2019. RESULTS: A total of 533,258 patients underwent elective benign hysterectomy. Between 2013 and 2020, minimally invasive hysterectomies increased from 73% to 83%. By 2020, robotic-assisted hysterectomy (RH) became the most common approach for morbidly obese women (40.8%). In the matched cohort of morbidly obese patients, RH was associated with reduced perioperative bleeding (2.8% vs. 4.0%, p = 0.003), a lower risk of conversion to open surgery (3.5% vs. 7.3%, p < 0.001), and shorter operative time (179 min vs. 186 min, p = 0.003) compared to laparoscopy. CONCLUSION: The use of robotic technology has facilitated the adoption of minimally invasive surgery for benign hysterectomy, particularly among patients with morbid obesity. When compared to standard laparoscopy in this high-risk population, robotic surgery was associated with improved perioperative outcomes. Morbidly obese patients may specifically benefit from the application of the robotic platform for benign hysterectomy.