Robotic-assisted versus laparoscopic hysterectomy in Stage I endometrial cancer: a real-world causal mediation analysis of operating time and length of hospital stay

@article{jain2026roboticassisted,
  title = {{Robotic-assisted versus laparoscopic hysterectomy in Stage I endometrial cancer: a real-world causal mediation analysis of operating time and length of hospital stay}},
  author = {Vandana Jain and Jaydip Bhaumik and Rama Joshi and Yogesh Kulkarni and Kanika B. Modi and Priya Bhati and Surender Dabas and Sudhir Rawal and Kaustav Basu and Rohit R. Ranade and Nidhi Nayyar and Priya Kapoor and Arunava Roy and Swapna Mishra and Somashekhar S. P. and Venkat P. and Prabhakar Pandey and Akhil Dahiya and Rajveer Bhaskar and Isha Sharma},
  journal = {Journal of Robotic Surgery},
  year = {2026},
  month = nov,
  doi = {10.1007/s11701-026-04097-8},
  url = {https://doi.org/10.1007/s11701-026-04097-8},
  note = {CC BY-NC-ND 4.0},
}

TY  - JOUR
TI  - Robotic-assisted versus laparoscopic hysterectomy in Stage I endometrial cancer: a real-world causal mediation analysis of operating time and length of hospital stay
AU  - Vandana Jain
AU  - Jaydip Bhaumik
AU  - Rama Joshi
AU  - Yogesh Kulkarni
AU  - Kanika B. Modi
AU  - Priya Bhati
AU  - Surender Dabas
AU  - Sudhir Rawal
AU  - Kaustav Basu
AU  - Rohit R. Ranade
AU  - Nidhi Nayyar
AU  - Priya Kapoor
AU  - Arunava Roy
AU  - Swapna Mishra
AU  - Somashekhar S. P.
AU  - Venkat P.
AU  - Prabhakar Pandey
AU  - Akhil Dahiya
AU  - Rajveer Bhaskar
AU  - Isha Sharma
PY  - 2026
DA  - 2026/11/03
JO  - Journal of Robotic Surgery
DO  - 10.1007/s11701-026-04097-8
UR  - https://doi.org/10.1007/s11701-026-04097-8
AB  - This study estimated the impact of robotic-assisted surgery (RAS) versus laparoscopy (LPS) on operating time (OT), length of hospital stay (LOHS), and examined mediation through perioperative factors. A secondary analysis of individual patient data from a retrospective multicenter study was conducted. Women with histologically confirmed stage I endometrial cancer (EC) undergoing hysterectomy between January 2010 and December 2023 were included. After inverse probability of treatment weighting (IPTW), baseline covariates achieved standardized mean differences below 0.10. The IPTW-weighted effect estimate of LPS relative to RAS, interpreted as an adjusted association under the assumption of no unmeasured confounding was, 31.4 min for OT (95% CI: 17.8, 46.2) and 0.93 days for LOHS (95% CI: 0.59, 1.34). Blood loss accounted for 11.3 min (36%) of the OT difference and 0.46 days (49%) of the LOHS difference, while other mediators contributed minimally. Direct effects not explained by the measured mediators accounted for 18.6 min (59%) of the OT difference and 0.43 days (46%) of the LOHS difference. At an annual volume of 100 cases, the IPTW-weighted difference between RAS and LPS corresponded to an estimated difference of approximately 52.4 operating-room hours and 93 inpatient bed-days. RAS was associated with shorter OT and LOHS than LPS after adjustment for measured baseline differences. Reduced intraoperative blood loss explained a substantial proportion of these differences, although a considerable residual effect remained unexplained by measured perioperative mediators. Annual resource utilization difference should be interpreted as an illustrative planning estimate rather than a guaranteed operational saving.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s11701-026-04097-8.
SN  - 1863-2483
SN  - 1863-2491
ER  -