Highlights from 41st Annual Association of Gynecologic Laparoscopists (AAGL) Meeting in Las Vegas
(Web Exclusive, November 2012)
Are hospital claims about the robotic approach to gynecologic surgery based on reliable data—or mostly hype?
Andrew M. Kaunitz, MD (Examining the Evidence, November 2012)
Robotically assisted hysterectomy for benign gynecologic disorders increased significantly between 2007 and 2010, according to a study published February 20, 2013, in JAMA.1 However, compared with laparoscopic hysterectomy, the robotic procedure appears to offer little short-term benefit and is accompanied by substantially increased costs.
In the cohort study of 264,758 women who underwent hysterectomy at 441 hospitals across the United States, Wright and colleagues analyzed the use of robotically assisted hysterectomy in comparison with the abdominal and laparoscopic approaches. They also compared in-house complication rates between the three approaches.
Use of the robot for hysterectomy increased from 0.5% of all hysterectomies in 2007 to 9.5% in 2010, and laparoscopic hysterectomy increased from 24.3% to 30.5%. The rates of abdominal hysterectomy declined in hospitals, regardless of whether the robotic approach was available.
Complication rates were similar between robotically assisted hysterectomy and laparoscopic hysterectomy (5.5% vs 5.3%; relative risk [RR], 1.03; 95% confidence interval [CI], 0.86–1.24). The need for transfusion (1.4% for the robotic approach vs 1.8% for laparoscopy; RR, 0.80; 95% CI, 0.55–1.15) and the rate of discharge to a nursing facility (0.2% vs 0.3%, respectively; RR, 0.79; 95% CI, 0.35–1.76) were similar between the laparoscopic and robotically assisted approaches. However, the total cost of robotic hysterectomy was $2,189 more per case, compared with the laparoscopic approach (95% CI, $2,030–$2,389).
“Proponents of robotic surgery have argued that robotic technology allows women who otherwise would undergo laparotomy to have a minimally invasive procedure,” write Wright and colleagues. “However, there is little to support these claims, and because both laparoscopic and robotically assisted hysterectomy are associated with low complication rates, it is unclear what benefits robotically assisted hysterectomy offers.”
The investigators also point out that, unlike other procedures such as prostatectomy, for which robotic assistance is used more frequently than conventional laparoscopic approaches, laparoscopic hysterectomy is already widely available.
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