Robotically-assisted hysterectomy usage significantly increased, little benefit


Robotically-assisted hysterectomy usage significantly increased, little benefit

The use of robotically-assisted hysterectomy has significantly increased, however, it offers few benefits in the short-term and costs substantially more compared to laparoscopic hysterectomy.

The finding came from new research which analyzed hysterectomies for benign gynecologic disorders between 2007 and 2010 and was published in JAMA.

Women affected by benign gynecologic disorders often undergo a hysterectomy. One in 9 American females will have the surgery at one point in her life.

The authors explained:

"While hysterectomy has traditionally been performed abdominally via laparotomy, vaginally, or by laparoscopy, robotically assisted hysterectomy has been introduced as an alternative minimally invasive approach to hysterectomy.

The robotic surgical platform received approval from the U.S. Food and Drug Administration in 2005 for the performance of gynecologic procedures and allows a surgeon to perform the procedure at a remote console."

Robotic surgery advocates have said that females can have a minimally invasive procedure by using robotic technology instead of laparatomy.

On the other hand, there is little evidence to back up these assertions, and since both procedures are linked to low rates of complication, scientists have not been sure what advantages robotically-assisted hysterectomy provides patients.

Laparoscopic hysterectomy is already extensively available, the researchers said, dissimilar to other methods such as prostatectomy, for which robotic assistance is more common than traditional laparoscopic approaches.

The team of experts, led by Jason D. Wright, M.D., of Columbia University College of Physicians and Surgeons, New York, observed the use of robotic-assisted hysterectomy.

In-hospital outcomes as well as the costs for robotically-assisted hysterectomy were evaluated and then compared to laparoscopic and abdominal procedures.

There were 264,758 women involved in the research who received hysterectomies for benign gynecologic disorders at 441 hospitals in the United States between 2007 and 2010.

Among all of the subjects:

  • 46.6% (123,288) had an abdominal hysterectomy
  • 28.6% (75,761) had a laparoscopic procedure
  • 20.7% (54,912) had a vaginal hysterectomy
  • 4.1% (10,797) had a robotically-assisted hysterectomy
Robotically-assisted hysterectomy increased, according to the team, and made up 0.5% of the procedures in 2007 versus 9.5 in 2010.

There was also a rise in the number of laparoscopic hysterectomies performed, the procedure made up 24.3% of the surgeries in 2007 vs. 30.5% in 2010.

Once robotically-assisted hysterectomies were introduced to a hospital, the use increased very quickly.

"For example, at 3 years after the first robotic procedure in each hospital where robotics were used, robotic-assisted hysterectomy accounted for 22.4 percent of all hysterectomies. At these hospitals, use of vaginal, laparoscopic, and abdominal hysterectomy all declined," the experts said.

"In contrast, at hospitals where robotically assisted hysterectomy was not performed, abdominal and vaginal hysterectomy declined, while use of laparoscopic hysterectomy increased."

Patients who received a robotic-assisted hysterectomy had a lower probability to stay longer than 2 days in the hospital (19.6 percent vs. 24.9 percent).

However, robotic-assisted hysterectomy and laparoscopic hysterectomy had similar complication rates (5.5 percent vs. 5.3 percent).

Previous research indicated that outcomes for robotic-assisted hysterectomy were comparable to traditional laparoscopy.

On the other hand, the costs linked to robotically-assisted hysterectomy were significantly more than for laparoscopic hysterectomy ($2,189 more per case).

The scientists concluded:

"Our findings highlight the importance of developing rational strategies to implement new surgical technologies. Robotic surgery first gained prominence for prostatectomy as it essentially offered the only minimally invasive surgical approach for the procedure. Hysterectomy is unlike prostatectomy in that a number of alternatives to open surgery are available; laparoscopic hysterectomy is a well- accepted procedure and vaginal hysterectomy allows removal of the uterus without any abdominal incisions.

From a public health standpoint, defining subsets of patients with benign gynecologic disorders who derive benefit from robotic hysterectomy, reducing the cost of robotic instrumentation, and developing initiatives to promote laparoscopic hysterectomy are warranted."

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Section Issues On Medicine: Women health