Robotic Surgery Seems Safe But Pricey

Hysterectomy surgical procedures evaluated for costs and complications

(RxWiki News) Robot technology is being used in surgical settings, but can cost a pretty penny. If two surgeries are equally safe, the less expensive procedure may be best.

A recent study looked at the four different types of surgery used to remove a woman’s uterus. Researchers studied complications, cost and hospital stay to see which surgical procedure was the safest and most cost effective.

Results showed that the robot-assisted and laparoscopic methods were equally safe with similar recovery times.

However, the laparoscopic method was over $2,000 less expensive.

"Talk to your gynecologist about surgical options."

Jason D. Wright, MD, from the Columbia University College of Physicians and Surgeons in New York, led a study to compare different surgical procedures used to remove a woman's uterus.

The authors estimated that one in nine women in the United States would have a hysterectomy (surgical removal of the uterus) in her lifetime for non-cancerous gynecologic disease. Researchers set out to compare costs and complications between different surgical methods for hysterectomies.

In US medical facilities, hysterectomies are done with one of four surgical procedures: the laparoscopic method, abdominal or open removal, vaginal removal or robot-assisted removal.

The laparoscopic method involves making small cuts to insert tubes with lighted cameras and modern surgical tools into the abdomen without having to open up the abdomen completely. Once the uterus has been freed from all connections in the abdomen, the uterus can be removed through the vaginal passage. 

In abdominal hysterectomies, the surgeon cuts open the abdomen to remove the uterus. Open procedures are invasive, leave bigger scars and may require longer hospital stays and recovery times.

Vaginal hysterectomies are done by entering and removing the uterus through the vaginal passage without any cuts made into the abdomen.

For patients, robotic-assisted hysterectomies are similar to the laparoscopic method. But instead of using using their hands, surgeons control a robot to move the laparoscopic instruments. The surgeon is allowed more natural wrist and hand movements when directing the robot to manipulate the laparoscopic tools, which are long and can be awkward.

For the study, researchers reviewed 264,758 hysterectomy cases for non-cancerous gynecologic disorders from 441 hospitals in the US between 2007 and 2010. A total of 47 percent of the women had an abdominal hysterectomy, 29 percent had a laparoscopic hysterectomy, 20 percent had a vaginal hysterectomy and 4 percent had a robotic-assisted hysterectomy.

The researchers found that while robotic-assisted hysterectomies averaged 4 percent of procedures over three years, they increased from less than 1 percent in 2007 to 10 percent in 2010. Laparoscopic hysterectomies increased from 24 percent in 2007 to 31 percent in 2010.

The rates of surgical and post-surgical complications for laparoscopic and robot-assisted hysterectomies were similar at 5.3 percent versus 5.5 percent, respectively.

Only 25 percent of laparoscopic patients had to stay in the hospital for longer than two days compared to 20 percent of robot-assisted patients.

The financial cost of robotic-assisted surgery was an average of $2,189 more per patient than the cost of laparoscopic surgery.

The authors concluded that robot-assisted hysterectomies were effective for patients, but much more expensive than a comparable laparoscopic procedure. They recommended finding ways to reduce the cost of robot-assisted hysterectomies and promoting laparoscopic hysterectomies over abdominal hysterectomies.

This study was published in February in the Journal of the American Medical Association. The National Cancer Institute provided funding for this research. No conflicts of interest were reported.

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Review Date: 
February 19, 2013