Is pharmacologic thromboprophylaxis needed in robotic-assisted hysterectomy? A big data study.

objectiveTo assess venous thromboembolism (VTE) rates and evaluate whether pharmacologic thromboprophylaxis is necessary for patients undergoing robotic versus laparoscopic hysterectomy.

methodsWe performed a retrospective longitudinal analysis of women who underwent minimally invasive hysterectomy within Clalit Health Services between 2000 and 2024. Surgical approach (laparoscopic or robotic) and the use of low-molecular-weight heparin (LMWH) were recorded. A subgroup analysis was conducted among patients who did not receive LMWH. VTE events were identified by ICD-10 codes for deep vein thrombosis (DVT) or pulmonary embolism (PE) occurring within 90 days postoperatively.

resultsOf 53,744 patients, 52,486 had laparoscopic hysterectomy and 1,258 underwent robotic surgery; 8,800 had endometrial cancer. Overall VTE incidence was low and did not differ between surgical approaches (0.4% vs. 0.6%; P = 0.59). Among patients with endometrial cancer, LMWH use was more common in the robotic group (48% vs. 17%; P < 0.001). Robotic surgery was associated with higher BMI and more frequent blood transfusion, but surgical route was not an independent predictor of VTE. Findings were similar in the subgroup that did not receive LMWH. Several factors—age, hypertension, BMI, and cancer diagnosis—were associated with VTE risk.

conclusionIn this large, real-world cohort, VTE rates after minimally invasive hysterectomy were low regardless of surgical approach. Robotic hysterectomy did not independently increase VTE risk, supporting individualized prophylaxis decisions rather than routine anticoagulation based solely on surgical modality.