Hysterectomy over the course of time. Retrospective analysis of surgical techniques at the University Gynecology Hospital Essen over the last 20 years

Introduction: Minimally invasive surgery has for a long time been the standard for performing hysterectomy for benign indications. In this context robotic-assisted operations are generally considered comparable to conventional laparoscopy. Furthermore, robot-assisted surgery has the potential to also enable complex minimally invasive interventions and to make laparotomy unnecessary in the majority of patients.Material and methods: A total of 1939 patients who underwent hysterectomy for benign indications at the University Gynecology Hospital Essen between 2002 and 2020 were identified. Perioperative and postoperative data and patient characteristics were retrospectively collated.Results: Robotic surgery has been carried out in this hospital since 2010 and was the most frequent surgical approach (n = 771; 39.8%) and 60.2% (1168/1938) of hysterectomies were carried out using minimally invasive surgery. Over the years there was a clear shift with respect to the access route. In 2002, 51.4% of all hysterectomies were carried out using an open procedure but in 2020 this was reduced to 1.4%. Correspondingly, the proportion of minimally invasive procedures rose from 18.9% in 2002 to 98.6% in 2020. The introduction of robotic surgery in 2010 led to a significant shift to minimally invasive procedures, which led to shorter times in bed and less postoperative complications compared to laparotomy. Furthermore, this cohort includes the largest uterine myoma ever reported in the scientific literature with a weight of 54.8 kg.Conclusion: These data support the hypothesis that the introduction of robotic surgery expands the possibilities for minimally invasive surgery, whereby laparotomy can be avoided in nearly all cases. The known advantages of minimally invasive surgery could be confirmed.