RESULTS

527217 elective gynaecological procedures were performed in the English NHS between 1st April 2006 and 31stMarch 2018, of which 4384 (0.83%) were performed with robotic assistance. These constituted: 3486 (80%) hysterectomy, 706 (16%) adnexal surgery, and 192 (4%) urogynaecological surgery. The total number of robotic procedures rose from 2/ 41173 (0%) in 2006-2007 to 1152/ 43929 (2.6%) in 2017-2018 (Figure 1,2).
Of the 141 NHS hospitals that provided gynaecological surgery during the study period, 76 hospitals (53.9%) had carried out at least one robotic procedure. The median number (interquartile range) of procedures by hospital was 5 (1-38). Of the 76 hospitals that had carried out robotic gynaecological surgery, 44 had performed 1 to 10 procedures (Figure 2).
The number of all robotic procedures was also mapped to the 44 STP areas. Median number (interquartile range) of procedures by STP area was 52 (16 to 148), demonstrating wide geographic variation in the uptake of robotic gynaecological surgery (Figure 3).
Only 99 robotic procedures were carried out between 1st April 2006 and 31st March 2010. Considering the 4285 robotic gynaecological procedures carried out from 1st April 2010 onwards, we observed an increase in the annual number of robotic hysterectomies from 124 in 2010-2011 to 928 in 2017-2018 and the annual number of adnexal surgeries from 18 in 2010-2011 to 211 in 2017-2018 (Table 1). The number of urogynaecological procedures was considerably lower with no evidence increase over time (13 in 2010-2011 and 14 in 2017-2018).
Median LOS (interquartile rage) was 1 (1-2), 1 (0-2) and 2 (1-3) nights, conversion to laparotomy rate 0.3%, 0.5% and 0%, and 30-day emergency readmission rate 4.8%, 4.7%, and 3.8% for hysterectomy, adnexal surgery and urogynaecological procedures, respectively with no evidence of changes over time during the study period (Table 1).