Minimally Invasive Hysterectomy and Power Morcellation Trends in a West Coast Integrated Health System

Area of Science:

• Gynecologic Surgery
• Surgical Trends
• Minimally Invasive Procedures

Background:

• Hysterectomy remains a common procedure for benign gynecologic conditions.
• Trends in surgical approaches, including minimally invasive techniques and power morcellation, are of significant clinical interest.
• Understanding these trends is crucial for optimizing patient care and surgical outcomes.

Purpose of the Study:

• To analyze temporal trends in minimally invasive hysterectomy and power morcellation utilization.
• To investigate the association between surgical route, power morcellation, and patient clinical characteristics.
• To evaluate complications related to different hysterectomy surgical routes.

Main Methods:

• Retrospective cohort study of 31,971 hysterectomies for benign conditions (2008-2015).
• Trend analysis using generalized estimating equations and Cochran-Armitage testing.
• Logistic regression to assess clinical characteristics and complications associated with surgical route.

Main Results:

• Minimally invasive hysterectomy increased from 39.8% to 93.1%, nearly replacing abdominal hysterectomies.
• Power morcellation use in nonrobotic laparoscopic hysterectomies peaked in 2013 and then sharply declined.
• Larger uteri were associated with abdominal hysterectomy and laparoscopic hysterectomy with power morcellation.

Conclusions:

• A high rate of minimally invasive hysterectomy is achievable and primarily linked to uterine size.
• Minimally invasive hysterectomy can be maintained at high rates without the routine use of power morcellation.
• Surgical decisions regarding hysterectomy route should consider uterine size and the risks associated with power morcellation.