For benign ovarian surgery, conventional laparoscopy causes fewer complications and is less expensive
With the rapid rise in the cost of cancer care, we need to make sure that public policies encourage comparative studies prior to widespread dissemination of new technologies
… “For benign gynecologic conditions, robot-assisted surgery involves statistically significant increase in complications during surgery and is associated with substantially greater costs than conventional laparoscopic surgery, according to a study by researchers at Columbia University Medical Center (CUMC)“…
Sources and more information:
Comparative Effectiveness of Robotically Assisted Compared With Laparoscopic Adnexal Surgery for Benign Gynecologic Disease, Obstetrics & Gynecology, October 6, 2014.
It is not clear how to identify which women would benefit from robotic surgery
With robotic hysterectomy, the surgeon has a greater degree of movement and control of the instruments and the visualization is better but does this change outcomes for patients? Doctors promise that robot-assisted surgeries reduce complications and speed up recovery, but new studies show the differences with laparoscopic hysterectomy to be minimal, while the cost is significantly higher.
A hysterectomy (removing the uterus) can be done via one of the four methods: vaginal, laparoscopic surgery, robotic surgery and abdominal hysterectomy. The American Congress of Obstetricians and Gynecologists recommends vaginal hysterectomy as the least invasive method with the best outcomes. Why are gynecologists pushing robotic hysterectomies?
Why are gynecologists pushing robotic hysterectomies?
” Robotically assisted hysterectomy increased dramatically from 2007 to 2010, despite higher cost and similar complication rates compared with laparoscopic procedures, a review of data from more than 400 hospitals showed. “
Comparative Effectiveness Research on Robotic Surgery
During the last 10 years, the use of robotic-assisted surgery has substantially increased, beginning with urologic procedures and expanding to include gynecologic procedures and many others. Robotic-assisted surgery is a type of minimally invasive procedure that in fact facilitates laparoscopic surgery. Both approaches provide benefits compared with open surgery, including smaller incisions, shorter hospital stays, less postoperative pain, and possibly quicker return to function. As of 2009, more than 200 000 robotically assisted operations had been performed worldwide. The reason for its rapid dissemination in the United States may be linked to a number of converging factors, including better ergonomics for the surgeon, marketing campaigns, and the national fascination with technology and innovation. Under other circumstances, this might be an unparalleled success story of US medical ingenuity. However, critics of robotic surgery claim that it is more expensive without providing a concomitant benefit. Sources.
Robotically Assisted vs Laparoscopic Hysterectomy Among Women With Benign Gynecologic Disease
Importance Although robotically assisted hysterectomy for benign gynecologic conditions has been reported, little is known about the incorporation of the procedure into practice, its complication profile, or its costs compared with other routes of hysterectomy.
Objectives To analyze the uptake of robotically assisted hysterectomy, to determine the association between use of robotic surgery and rates of abdominal and laparoscopic hysterectomy, and to compare the in-house complications of robotically assisted hysterectomy vs abdominal and laparoscopic procedures.
Design, Setting, and Patients Cohort study of 264 758 women who underwent hysterectomy for benign gynecologic disorders at 441 hospitals across the United States from 2007 to 2010.
Main Outcome Measures Uptake of and factors associated with utilization of robotically assisted hysterectomy. Complications, transfusion, reoperation, length of stay, death, and cost for women who underwent robotic hysterectomy compared with both abdominal and laparoscopic procedures were analyzed.
Results Use of robotically assisted hysterectomy increased from 0.5% in 2007 to 9.5% of all hysterectomies in 2010. During the same time period, laparoscopic hysterectomy rates increased from 24.3% to 30.5%. Three years after the first robotic procedure at hospitals where robotically assisted hysterectomy was performed, robotically assisted hysterectomy accounted for 22.4% of all hysterectomies. The rates of abdominal hysterectomy decreased both in hospitals where robotic-assisted hysterectomy was performed as well as in those where it was not performed. In a propensity score–matched analysis, the overall complication rates were similar for robotic-assisted and laparoscopic hysterectomy (5.5% vs 5.3%; relative risk [RR], 1.03; 95% CI, 0.86-1.24). Although patients who underwent a robotic-assisted hysterectomy were less likely to have a length of stay longer than 2 days (19.6% vs 24.9%; RR, 0.78, 95% CI, 0.67-0.92), transfusion requirements (1.4% vs 1.8%; RR, 0.80; 95% CI, 0.55-1.16) and the rate of discharge to a nursing facility (0.2% vs 0.3%; RR, 0.79; 95% CI, 0.35-1.76) were similar. Total costs associated with robotically assisted hysterectomy were $2189 (95% CI, $2030-$2349) more per case than for laparoscopic hysterectomy.
Conclusions and Relevance Between 2007 and 2010, the use of robotically assisted hysterectomy for benign gynecologic disorders increased substantially. Robotically assisted and laparoscopic hysterectomy had similar morbidity profiles, but the use of robotic technology resulted in substantially more costs.