Robotic-assisted surgery implementation and trends in surgical approaches for benign hysterectomies: A 12-Year hospital level ecological analysis in a French tertiary hospital network.

STUDY OBJECTIVE: To assess the temporal associations between the implementation of robotic-assisted surgery (RAS) and changes in the hysterectomy surgical approach for benign disease, with a focus on open surgery (OS). METHODS: Multicentre retrospective hospital-level ecological study using data from the French national medico-administrative database Programme de Médicalisation des Systèmes d'Information (PMSI). All patients who underwent hysterectomy for benign gynaecologic indications between January 1, 2012, and December 31, 2023. Fourteen university hospitals within the Assistance Publique-Hôpitaux de Paris (AP-HP) network were divided into two groups: a robotic hospital group which included seven centres where a RAS platform was implanted in 2019, and a non-robotic hospital group which included seven centres where the RAS platform was implemented. Hysterectomy was performed via OS, conventional laparoscopy vaginal, or RAS approaches. RESULTS: A total of 17,170 benign hysterectomies were included (11,668 (68.0%) in the robotic hospital group and 5,502 (32.0%) in the non-robotic hospital group). Between 2012 and 2018, OS rates decreased similarly in both groups (-5.6%/year vs. -5.3%/year; p = 0.97). Between 2019 and 2023, trends diverged significantly (p < 0.01): OS continued to decline in the robotic hospital group (-5.9%/year) but remained stable in the non-robotic hospital group (+0.6%/year). In the robotic hospital group, RAS increased to 32% by 2023, partially substituting conventional laparoscopy. CONCLUSION: In this academic hospital network, RAS implementation was temporally associated with lower OS routes rates for benign hysterectomy, although robotic surgery widely replaced laparoscopy. In centres where robotic surgery was not performed, the laparotomy rate did not decrease.