INTRODUCTION: Hysterectomy is the most common non-obstetric surgical procedure women in the United States undergo. Minimally invasive gynecologic surgery (MIGS) subspecialists have been shown to perform hysterectomies for more complex pathology in less time with no increase in complication rates and have higher surgical volumes. OBJECTIVE: To compare abdominal hysterectomy (AH) rates between fellowship-trained MIGS subspecialists and non-MIGS surgeons and to evaluate trends over time from 2020 to 2024. METHODS: This study was a retrospective cohort study that included patients who underwent benign hysterectomy between January 2020 and May 2025 at seven tertiary and quaternary care hospitals across the United States within a single-payer healthcare system. Facilities were included if they offered graduate medical education to obstetrics and gynecology residents, with or without MIGS subspecialists, to ensure the resources were similar across sites (OBGYN subspecialties, other surgical specialties, blood bank capabilities, robotic surgery platform). Data was extracted from a database for the health system that contains encounter-level de-identified data and eligible encounters were identified using CPT codes. Individual percentages of relevance to study objectives were compared by MIGS vs non-MIGS surgeon and by year using chi-square tests. A 2-sided p-value of <.05 was considered statistically significant. RESULTS: A total of 5,872 hysterectomy encounters were included, of which 608 (10.4%) were performed by MIGS subspecialists and 5,264 (89.6%) by non-MIGS surgeons. The overall rate of AH was 10.8%, 69.6% for laparoscopic hysterectomy (LH), and 19.6% for vaginal hysterectomy (VH). MIGS subspecialists had an overall AH rate of 4.8% (n=29) compared to 11.5% (n=607) for non-MIGS surgeons (p<.001). At each facility, the MIGS AH rate was significantly lower than non-MIGS: 5.5% vs 13.5% at Hospital A, 1.7% vs 7.9% at Hospital B, and 5.0% vs 13.2% at Hospital C (p<.001). At the other facilities without MIGS subspecialists, the AH rates ranged from 8.3% to 15.3%. Between 2020 and 2024, the percentage of hysterectomies performed by MIGS subspecialists increased from 7.7% to 14.0% and the overall AH rate decreased from 12.9% to 9.0% (p<.001). “Hospital A, B, and C” were used to replaced facility names to disguise author identity. CONCLUSIONS: Fellowship-trained MIGS subspecialists had a significantly lower AH rate compared to non-MIGS surgeons. As MIGS subspecialists performed an increasing proportion of the hysterectomies within the health system, the overall AH rate decreased. These findings support the value of MIGS fellowship training and the important role that MIGS subspecialists play in increasing access to minimally invasive hysterectomy, which benefits patients, medical trainees, hospitals, and healthcare systems.Figure 1Table 1
Edmonds et al. (Fri,) studied this question.