What Type of Hysterectomy is Best?

Robot assisted hysterectomy similar to laparoscopic hysterectomy in outcomes but more expensive

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) The surgical removal of the uterus, or a hysterectomy, is the most common surgery in the United States. There are different methods for hysterectomy; so which one is a better option?

A recent study compared the rates, general outcomes and financial cost of robot-assisted hysterectomy (computer-operated surgery) versus laparoscopic hysterectomy (surgeon does the surgery) for non-cancerous disease.

The researchers found that the number of patients having a robotic hysterectomy has increased, but laparoscopic hysterectomy is still more popular. The study also showed that the general outcomes of both methods were similar, but robotic hysterectomies cost more.

The researchers concluded that the comparative effectiveness of robot-assisted versus laparoscopic hysterectomy should be continuously examined as robot-assisted hysterectomies become more advanced and used regularly.

"Discuss the different options for hysterectomy with your gynecologist."

This study was conducted through the Departments of Anesthesiology and Pain Management, and Obstetrics and Gynecology of the University of Texas Southwestern Medical Center in Dallas, Texas. The lead author was Kimberly A. Kho, MD, MPH, from the Department of Obstetrics and Gynecology at UT Southwestern.

A laparoscopic hysterectomy involves the surgeon making a small cut on the abdomen, inserting a camera and operating on a patient while looking through the camera. A robot-assisted hysterectomy means that a robot is operating on the patient, and the surgeon is operating a computer that is controlling the robot.

The authors of this study explained that robot-assisted surgery was developed to overcome some of the limitations of laparoscopic surgery. Advantages to this method include a wider range of motion for operating, a three-dimensional view of the surgical area and more comfortable hand movements by the surgeon.

The participant data came from the Nationwide Inpatient Sample (NIS) from years 2009 to 2010.

The NIS is the largest all-payer inpatient database for hospitalizations in the United States, and includes demographic data (age, sex, race, etc.) and hospital data (length of stay, hospital charges, teaching/nonteaching, etc.)

The researchers used data on any woman over 18 who had any type of hysterectomy for non-cancerous disease.

The researchers compared data on in-hospital deaths, length of hospital stay, cost of hospital care and whether there were any negative side effects of the operation for laparoscopic versus robot-assisted hysterectomy.

The researchers found that there were a total of 804,551 hysterectomies performed for non-cancerous disease during 2009 to 2010.

In 2009, 20 percent (86,253) of the hysterectomies were laparoscopic, and 4 percent (17,587) were robot-assisted. In 2010, 21 percent (79,128) were laparoscopic, and 6 percent (23,654) were robot-assisted.

These findings showed a one percent increase in laparoscopic hysterectomies from 2009 to 2010, and a two percent increase in robot-assisted hysterectomies from 2009 to 2010. The researchers determined that laparoscopic hysterectomies accounted for 21 percent of the total hysterectomies during 2009 and 2010, and robot-assisted accounted for 5 percent.

Overall, the average cost for robot-assisted hysterectomy was $9,788, whereas the average cost for laparoscopic hysterectomy was $7,299. 

The researchers discovered that patients who had robot-assisted hysterectomy were generally older and more likely to have other medical conditions, to have private insurance or Medicare, to live in an area with a higher-than-average household income and to have had the surgery done in an urban hospital.

The researchers then selected 7,778 patients from each surgery group with similar demographic and hospital data in order to compare in-hospital deaths, negative side effects and average length of hospital stay. The in-hospital death rates and negative side effects — either medically or surgically — were not statistically different. The average lengths of stay also did not differ.

These findings revealed that the greater cost of robot-assisted hysterectomy did not lead to better outcomes.

The authors mentioned multiple limitations of their study.

First, the NIS only represents 20 percent of hospitalizations in any year across 45 states, so the researchers may have underestimated rates of surgery or complications. Second, the NIS doesn't include data on patient-specific surgeries such as patient weight, operating time or physician specialty.

Third, the researchers could not factor the cost of the robot. Lastly, the NIS could not provide information on physician charges, ambulance cost or any secondary charges of the surgery.

This study was published online ahead-of-print in the September edition of Obstetrics & Gynecology.

Funding was provided by a grant from the National Institutes of Health and the National Center for Advancing Translational Sciences.

Review Date: 
September 11, 2013
Last Updated:
September 12, 2013