Robotic Hysterectomy Is No Better than Laparoscopic Procedure

Robotic surgical procedures have been made available in many hospitals around the country, in the hopes of attracting patients interested in the concept of ‘an infallible surgeon’.  The use of robots for prostatectomy has increased in the last  few years – although prostate cancer rates are decreasing in the USA, 60% more prostatectomies have been done during 2005 to 2008, driven by the increased use of robotics.  Indeed, vendors have promoted the use of their surgical robots to physicians and the potential consumer; shopping-mall demos induce patients to come to the doctor’s office, asking for robotic procedures.  All this is why a report given at the European Society of Gynecological Oncology is so important.  It shows the actual value of robotics for hysterectomy. 

Columbia University, NYC, investigators identified minimally invasive hysterectomy procedures for endometrial cancer, and classified each procedure as laparoscopic or robotic. There were 2,464 such procedures – 42% laparoscopic and 58% robotic.  Robotic surgery was more likely to be selected at large, non-teaching hospitals, but less likely in blacks, uninsured patients, and those living in the country.

There was no significant difference between overall problems during hospitalization (such as injury during surgery, transfusion, prolonged hospital stay or non-routine discharge) between the laparoscopic and robotic groups; the rates were 9.8% and 8.1%, respectively.  Laparoscopy was associated with a significantly higher rate of medical complications (4.9% vs. 2.9%), while robotics had more surgical-site complications (2.9% vs. 1.8%).

When it came to costs, each laparoscopic procedure cost, on average, $8,996 compared with $10,618 for each robotic procedure. The difference amounts to about 16%.  In a word (or a couple of words) robotic techniques did not improve outcomes over laparoscopic hysterectomy, and cost ~16% more.  Before new robotic approaches for other common surgical procedures are introduced and widely implemented, comparison studies like this one should be done, and their result made public.