Robotic Surgery: more complications, higher expense for some conditions

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:

What is Robotic Surgery? Advantages Disadvantages compared to Laparoscopy and Laparotomy

Is robotic surgery right for everyone?

What is robotic surgery?
ASRM is a non-profit organization devoted to advancing knowledge and expertise in reproductive medicine including infertility, menopause, and sexuality.

The Patient Education Website of the American Society for Reproductive Medicine adresses these questions:

  • What is robotic surgery?
  • What are the advantages of robotic surgery compared to traditional laparoscopy?
  • What are the advantages of robotic surgery compared to laparotomy (open incision)?
  • Are there any disadvantages of robotic surgery?
  • What are the most common surgical procedures performed by robotic surgery?
  • Is robotic surgery right for everyone?

Read ASRM Robotic Surgery, American Society for Reprocutive Medicine, Revised 2012 – PDF.

Related posts:

More Questions about Robotic Hysterectomy, Robot-assisted Hysterectomies

It is not clear how to identify which women would benefit from robotic surgery

More Questions about Robotic Hysterectomy
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.

Read Questions About Robotic Hysterectomy
by Roni Caryn RabinTheNewYorkTimes, 25 Feb 2013

Related posts:

With no Advantage to Robotic Hysterectomies, why are Gynecologists pushing them?

Should you choose to have a robotic hysterectomy?

Should you choose to have a robotic hysterectomy?
Robotically assisted hysterectomy has increased dramatically

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?

Read Should you choose to have a robotic hysterectomy?
by Jennifer Gunter, MD, 20 May 2013

Related posts:

Use of Robots for Hysterectomy Soars, but with Little Benefit

Why are gynecologists pushing robotic hysterectomies?

Use of Robots for Hysterectomy Soars, but with Little BenefitRobotically 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. “

Read Use of Robots for Hysterectomy Soars, but with Little Benefit
by Charles Bankhead, MedPage Today.

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

Abstract

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.