Minor Intraoperative Advantages of Robotic Hysterectomy May Not Improve Postoperative Recovery Outcomes: Study
Sweden: Secondary analysis of the RACC randomized clinical trial demonstrates that while robot-assisted radical hysterectomy reduces minor, lower-grade intraoperative complications compared to open surgery, it yields no significant difference in postoperative morbidity. Additionally, early health-related quality of life (HRQOL) differences between the two procedures remain minimal, indicating that the robotic approach does not translate into improved recovery or better long-term clinical outcomes.
Published in JAMA Surgery, the analysis was led by Sahar Salehi, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden, and colleagues. The researchers evaluated perioperative safety and early patient-reported outcomes among women undergoing radical hysterectomy for early-stage cervical cancer.
The analysis used data from the Robot-Assisted Approach to Cervical Cancer (RACC) trial, a multicenter, phase 3 randomized clinical trial conducted at tertiary centers across Europe. The trial enrolled women aged 18 years and older with cervical cancer classified as FIGO 2018 stage IB, excluding IB3, or stage IIA1. Participants were randomized between 2019 and 2025 to undergo either robot-assisted laparoscopic radical hysterectomy or open surgery.
Among 900 randomized patients, 809 were included in the intraoperative safety analysis, 798 in the postoperative safety analysis, and 723 in the assessment of HRQOL at one month.
The findings showed:
- Intraoperative complications occurred in 5.7% of patients undergoing robot-assisted surgery versus 10.0% with open surgery.
- Most of the difference involved lower-grade complications, while major intraoperative events were uncommon and occurred at similar rates.
- 30-day postoperative complications were comparable between the groups, occurring in 33.4% of robotic-surgery patients versus 34.8% of those undergoing open surgery.
- Rates of readmission and reoperation were also similar between the approaches.
- At one month, robotic surgery was associated with modest improvements in physical functioning, role functioning and pain, but most HRQOL measures did not reach thresholds considered clinically meaningful.
The results indicate that the principal perioperative advantage of robotic surgery was a reduction in less severe intraoperative events. This benefit did not extend to major postoperative complications or produce a broad improvement in early recovery.
The researchers noted that the findings were exploratory, as the secondary analyses were not powered for definitive comparisons or adjusted for multiple testing. Differences in surgical expertise and institutional practices, as well as potential underreporting or misclassification of intraoperative complications, may also have influenced the results.
Importantly, these findings do not establish overall clinical or oncologic superiority of either surgical approach, as the primary cancer outcomes from the RACC trial are still awaited.
Overall, robot-assisted surgery reduced mainly lower-grade intraoperative complications but did not improve postoperative morbidity or overall recovery compared with open surgery. Final treatment decisions should also consider the forthcoming oncologic outcomes.
Reference:
Salehi S, Norberg Hardie A, Smolders RGV, et al. Perioperative Outcomes and Recovery After Robot-Assisted vs Open Radical Hysterectomy: A Secondary Analysis of the RACC Randomized Clinical Trial. JAMA Surg. Published online October 07, 2026. doi:10.1001/jamasurg.2026.4625
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