Adoption of robot-assisted surgery for hysterectomy in France: a nationwide analysis of surgical routes and length of hospital stay (2020-2024).

BACKGROUND

Robot-assisted hysterectomy (RAH) has been progressively introduced in gynecologic surgery, yet nationwide data describing its uptake and early efficiency outcomes remain limited. We described trends in surgical route for hysterectomy within France and evaluate the length of hospital stay (LoS) according to surgical route and center expertise in robot-assisted surgery (RAS).

METHODS

All total hysterectomies (excluding vaginal) performed in France between January 2020 and December 2024 were identified from the national Programme de Médicalisation des Systèmes d'Informations (PMSI) registry. Procedures were categorized as open, laparoscopic hysterectomy (LH), or RAH and stratified by indication (endometriosis, other benign conditions, malignancy) and by center expertise in RAS, including multidisciplinary RAS centers. Primary outcomes were surgical volumes by approach and LoS.

RESULTS

Among 196,050 hysterectomies, LH remained the predominant approach; nevertheless, the proportion of RAH increased steadily across all indications over time, mainly at the expense of open surgery. This increase was more pronounced in high-volume and multidisciplinary RAS centers. Across indications, LoS was consistently shorter after minimally invasive surgery than after open hysterectomy. LoS following RAH was comparable to LH and decreased progressively over time. In experienced and multidisciplinary RAS centers, RAH was associated with the lowest LoS for benign indications.

CONCLUSIONS

These nationwide, real-world findings show that RAH is increasingly being integrated into minimally invasive hysterectomy pathways within France, with LoS comparable to laparoscopy and shorter than open surgery. Our results support the role of RAS expertise and multidisciplinary organization in optimizing early clinical and operational outcomes during the adoption of gynecologic RAS.