Trends in Laparoscopic and Robot-Assisted Surgery in Gynecology: A 10-Year Nationwide Study in Japan

To investigate recent trends in laparoscopic and robot-assisted surgery in gynecology in Japan.

This study analyzed National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data from April 2014 to March 2024. We investigated the number of hysterectomies performed for benign diseases, uterine prolapse surgeries, and surgeries for uterine cancer. Subgroup analyses were performed according to the patient age.

Among hysterectomies for benign diseases, laparoscopic hysterectomies (LHs) increased markedly, from 16 016 (29.4%) in 2014 to 34 429 (53.4%) in 2023. The number of robot-assisted hysterectomies increased from 462 (0.8%) in 2018, when first insured, to 8088 (12.5%) in 2023. Conversely, conventional hysterectomies decreased from 38 398 in 2014 to 21 975 in 2023. Among the surgeries for uterine prolapse, the number of laparoscopic sacrocolpopexies (LSCs) increased from 1478 (15.2%) in 2016 to 4147 (35.4%) in 2019. After robot-assisted sacrocolpopexy was covered by insurance, its numbers increased to 2994 (23.0%) in 2023, while LSCs declined slightly (3765 cases [28.9%] in 2023). For uterine malignancies, the number of laparoscopic and robot-assisted surgeries for early-stage endometrial cancer increased from 1180 in 2014 to 6104 in 2023, whereas that for laparoscopic surgeries for cervical cancer remained generally stable.

The use of laparoscopic and robot-assisted surgeries has grown steadily for hysterectomy for benign diseases, uterine prolapse surgery, and endometrial cancer surgery. After the approval of robotic surgery, LH for benign diseases and laparoscopic surgery for endometrial cancer showed a slight increase, whereas LSCs began to decline slightly.