Robotic Hysterectomy Shows Little Benefit

Rapid growth of robotic hysterectomy procedure volume continues despite a lack of data to support any advantages over conventional laparoscopic hysterectomy, claims a new study.

Researchers at Columbia University (New York, NY, USA) conducted a cohort study of 264,758 women who underwent hysterectomy for benign gynecologic disorders at 441 hospitals across the United States from 2007 to 2010. The researchers analyzed 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 both procedures. The main outcome measures were uptake of and factors associated with utilization of robotically assisted hysterectomy.

The results showed that the 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%. The overall complication rates were similar for robotic-assisted and laparoscopic hysterectomy (5.5% versus 5.3%). Robotic-assisted hysterectomy patients were less likely to have a length of stay longer than two days, but transfusion requirements and the rate of discharge to a nursing facility were similar. Total costs associated with robotically assisted hysterectomy were USD 2,189 higher per case than for laparoscopic hysterectomy. The study was published in the February 20, 2012, issue of the Journal of the American Medical Association (JAMA).

“The uptake of laparoscopic hysterectomy has occurred slowly, given that the technique has been available since the 1990s. By comparison, uptake of robotic hysterectomy has been rapid,” said lead author Jason Wright, MD. “Our study indicates that, while robotic assistance was associated with increased use of minimally invasive surgery for hysterectomy, when compared with laparoscopic hysterectomy, the robotic procedure offers little short-term benefit and is accompanied by significantly higher costs.”

Robotically assisted surgery has several potential benefits that have driven interest in and use of the technology since the FDA approved the surgical platform in 2005. Among the possible benefits are a wider range of motion with instrumentation and three-dimensional (3D) stereoscopic visualization, and the fact that users can work from an ergonomically friendly console. Proponents of robotic hysterectomy have asserted that the approach extends minimally invasive surgery to women who otherwise would undergo laparotomy, but offer little supporting evidence to that claim.

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