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Uptake and outcomes of robotic gynaecological surgery in England (2006-2018): a study using administrative hospital data.
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  • Dina El-Hamamsy,
  • Rebecca Geary,
  • Ipek Gurol-Urganci,
  • Jan van der Meulen,
  • Douglas Tincello
Dina El-Hamamsy
Leicester General Hospital
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Rebecca Geary
London School of Hygiene and Tropical Medicine
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Ipek Gurol-Urganci
London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy
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Jan van der Meulen
London School of Hygiene and Tropical Medicine
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Douglas Tincello
University of Leicester
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Abstract

Objective: To review uptake and outcomes of robotic gynaecological surgery in England between 1st April 2006 and 31st March 2018. Design: Retrospective cohort study. Setting: Hospitals of the English National Health Service (NHS). Population or sample: Women aged 18 years and above who had elective gynaecological surgery. Methods: Robotic gynaecological procedures were defined as procedures that used a robotic minimal access approach for hysterectomy, adnexal surgery and urogynaecological surgery (sacrocolpopexy, sacrohysteropexy and colposuspension). Numbers of procedures were reviewed by year and mapped to the 44 NHS regions. Main outcome measures: Length of stay (nights in hospital), laparotomy (conversion during primary procedure or after return to theatre for management of complication), and 30-day emergency readmission rates by year and procedure type. Results: 527217 elective gynaecological procedures were performed in the English NHS (1st April 2006 and 31st March 2018), of which 4384 (0.83%) were performed with robotic assistance (3864 (88%) hysterectomy, 706 (16%) adnexal surgery, 192 (4%) urogynaecological surgery). There was gradual rise in uptake but marked geographical variation. Median (IQR) length of stay (LOS) was 1(1-2) night, laparotomy rate: 0.3% and 30-day emergency readmission rate: 4.7%. LOS was statistically but not clinically different across time. Other outcomes did not differ by year. Conclusions: Robotic gynaecological procedures is increasingly being used in the English NHS, predominantly for hysterectomy, although overall in small proportions (2.6% in the most recent study year). There was wide geographical variation in robotic uptake across England and overall, outcomes were comparable to those reported in other countries.