Robotic assisted hysterectomy in a teaching hospital over ten years: trends, outcomes and service evolution

Abhishek Malakar; Amrit Pokharel; Fizza Javaid; Susanne Booth; Theo Giannopoulos; Gediminas Juknevicius

doi:10.18203/2320-1770.ijrcog20262515

Authors

Abhishek Malakar Department of Obstetrics & Gynaecology, Hull University Teaching Hospitals NHS Trust, UK https://orcid.org/0000-0001-5858-0392
Amrit Pokharel Department of Obstetrics & Gynaecology, Hull University Teaching Hospitals NHS Trust, UK
Fizza Javaid Department of Obstetrics & Gynaecology, Hull University Teaching Hospitals NHS Trust, UK
Susanne Booth Department of Gynae Oncology, Hull University Teaching Hospitals NHS Trust, UK
Theo Giannopoulos Department of Gynae Oncology, Hull University Teaching Hospitals NHS Trust, UK
Gediminas Juknevicius Department of Anaestheology, Hull University Teaching Hospitals NHS Trust, UK

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20262515

Keywords:

Robotic hysterectomy, Complications, Trend, Outcomes, Endometrial cancer

Abstract

Background: Robotic hysterectomy is increasingly utilised in gynaecology, particularly for patients with obesity, significant comorbidities, or oncological indications. Castle Hill Hospital established a robotic hysterectomy service in 2016. This study evaluates perioperative outcomes and trends in operative efficiency over a ten-year period in a high-risk, complex cohort.

Methods: Authors conducted a retrospective review of 374 patients who underwent robotic hysterectomy between 2016 and 2025. Collected data included patient age, BMI, comorbidities, prior abdominal surgery, surgical indication, intra- and postoperative complications, conversion to laparotomy, hospital stay and mean operating times.

Results: Patient ages ranged from 29 to 87 years. Obesity was common, with 81% having a BMI ≥30, and 71% had multiple comorbidities, most frequently cardiovascular or metabolic. One-quarter had a history of open abdominal surgery. Endometrial cancer was the primary indication in 65%, mostly early-stage. Additional procedures included pelvic lymph node sampling (84 cases), adhesiolysis, omental biopsy, omentectomy, and appendectomy. Forty-one women (10.96%) had intraoperative complications, out of which 23 (6.15%) had conversion to laparotomy, mostly due to surgical difficulty, bleeding, adhesion or for specimen retrieval. Postoperative complications were seen in 10.4%, with two returns to theatre. Length of stay was brief, with 76% discharged within 48 hours. Mean operating time improved from 193–195 minutes in 2016–2017 to 140 minutes (2025).

Conclusion: Robotic hysterectomy is safe and effective in complex, high-risk patients. Low complication and conversion rates, short hospital stays, and improved operative efficiency reflect increasing service maturity, reduced resource use, and potential cost-effectiveness.

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