Nationwide trends in and regional factors associated with minimally invasive hysterectomy for benign indications in Japan

•Minimally invasive hysterectomy is increasing over time in Japan nationwide.•Significant regional disparities are associated with the number of laparoscopy-qualified gynecologists.•More than 50% of hysterectomies have been performed as MIS since 2019. To examine the prevalence trends of minimally invasive hysterectomy for benign indications in Japan and investigate regional disparities. A retrospective cohort and ecological study using “The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data”. Nationwide Japan. Individuals who underwent hysterectomy for benign indications from 2014 to 2020. Trend analysis of minimally invasive surgery (MIS) rates through laparoscopic hysterectomies (LH) and robotic-assisted laparoscopic hysterectomies (RA-LH) at the national and prefecture levels. Examination of regional factors contributing to the disparity in MIS implementation rates by second medical service area (SMSA). The number of LH has increased from 16,016 in 2014 to 27,755 in 2020. The nationwide MIS hysterectomy rate increased from 29% in 2014 to 55% in 2020 (p less than 0.001). More than 50% of hysterectomies have been performed as MIS since 2019. There was an increasing trend in MIS rates in all age groups. All prefectures except one showed a significant upward trend (p less than 0.05) in the MIS rates, but MIS rates varied widely (23–84%). In a multivariable model, the MIS was more likely to be performed in the SMSAs in western Japan (p = 0.011), in the SMSAs where the number of laparoscopy-qualified gynecologists is 5–10 (p = 0.013), and 11 or higher (p less than 0.001). This study reveals a shift towards minimally invasive surgery (MIS) in total hysterectomy procedures in Japan. However, significant disparities in the prevalence of MIS hysterectomy exist, potentially influenced by the number of laparoscopy-qualified gynecologists.