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Adnexal disease as primary indication for surgery Minimally invasive hysterectomy converted intraoperatively Adnexal torsion Müllerian or uterine anomalies Age <18 years Ovarian, fallopian tube, or primary peritoneal cancer Cervical cancer more advanced than stage 1A1 Pelvic kidney Cesarean hysterectomy Planned appendectomy, cholecystectomy, or bowel surgery Concomitant anti-incontinence procedures Planned umbilical hernia repair affecting route choice Concomitant pelvic organ prolapse operation other than pure uterine Radical hysterectomy Emergent hysterectomy Risk-reducing surgery (ie, BRCA positive) Endometrial hyperplasia of increased complexity Supracervical hysterectomy History of multiple cone excisions with no available cervical tissue Tubo-ovarian abscess Laparoscopic hysterectomy or laparoscopy-assisted vaginal hysterectomy Uterine cancer or suspicion for sarcoma Mesh-related surgery or excision Route of Hysterectomy Variable Abdominal, n=62 Robotic, n=303 Vaginal, n=41 Age, years, mean ± SD 44.35 ± 5.88 44.7 ± 7.75 47 ± 10.36 Body mass index, kg/m2, mean ± SD 34.61 ± 7.34 32.46 ± 8.5 29.86 ± 6.74 Race/ethnicity Black/African American 56 (90.3) 164 (54.1) 16 (39.0) Caucasian 6 (9.7) 130 (42.9) 22 (53.7) Hispanic, nonwhite – 5 (1.7) 2 (4.9) Asian – 4 (1.3) 1 (2.4) Note: Data are presented as n (%) unless otherwise indicated.
Optimal Route Selection by Preoperative Analysis Optimal Route Selection by Postoperative Analysis Booked Surgical Approach Abdominal Laparoscopic Vaginal Abdominal Laparoscopic Vaginal Abdominal, n=62 25 (40.3) 30 (48.4) 7 (11.3) 32 (51.6) 27 (43.5) 3 (4.8) Robotic, n=303 19 (6.3) 132 (43.6) 152 (50.2) 3 (1.0) 173 (57.1) 127 (41.9) Vaginal, n=41 0 (0) 7 (17.1) 34 (82.9) 0 (0) 2 (4.9) 39 (95.1) Note: Data are presented as n (%).
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