Robotic hysterectomy versus expert 3D laparoscopy: A risk-adjusted learning curve analysis from a prospective single-surgeon study

Minimally invasive hysterectomy is preferred for benign gynaecologic conditions. Robotic-assisted hysterectomy (RAH) offers ergonomic and technical advantages over conventional laparoscopy, but whether it enhances performance beyond expert-level 3D laparoscopy remains uncertain. This prospective, single-surgeon study compared 50 RAH cases with 147 3D total laparoscopic hysterectomies (3D-TLH) by the high volume surgeon experienced in 3D laparoscopy and started robotic surgery soon after certification for DaVinci Xi robotic platform. A risk-adjusted cumulative sum (CUSUM) model, using operative time predicted from the surgeon's own 3D-TLH regression (Duration ∼ Uterine weight), was applied to assess proficiency. Outcomes were stratified by uterine weight (