Comparative Effectiveness Research on Robotic Surgery Comparative Effectiveness and Robotic Surgery

Weissman JS, Zinner M. — Wed, 20 Feb 2013 00:00:00 GMT

During the last 10 years, the use of robotic-assisted surgery has substantially increased, beginning with urologic procedures and expanding to include gynecologic procedures and many others. Robotic-assisted surgery is a type of minimally invasive procedure that in fact facilitates laparoscopic surgery. Both approaches provide benefits compared with open surgery, including smaller incisions, shorter hospital stays, less postoperative pain, and possibly quicker return to function. As of 2009, more than 200 000 robotically assisted operations had been performed worldwide. The reason for its rapid dissemination in the United States may be linked to a number of converging factors, including better ergonomics for the surgeon, marketing campaigns, and the national fascination with technology and innovation. Under other circumstances, this might be an unparalleled success story of US medical ingenuity. However, critics of robotic surgery claim that it is more expensive without providing a concomitant benefit.

Robotically Assisted vs Laparoscopic Hysterectomy Among Women With Benign Gynecologic Disease Prevalence of Robotically Assisted Hysterectomy

Wright JD, Ananth CV, Lewin SN, et al. — Wed, 20 Feb 2013 00:00:00 GMT

Importance

Although robotically assisted hysterectomy for benign gynecologic conditions has been reported, little is known about the incorporation of the procedure into practice, its complication profile, or its costs compared with other routes of hysterectomy.

Objectives

To analyze the 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 robotically assisted hysterectomy vs abdominal and laparoscopic procedures.

Design, Setting, and Patients

Cohort study of 264 758 women who underwent hysterectomy for benign gynecologic disorders at 441 hospitals across the United States from 2007 to 2010.

Main Outcome Measures

Uptake of and factors associated with utilization of robotically assisted hysterectomy. Complications, transfusion, reoperation, length of stay, death, and cost for women who underwent robotic hysterectomy compared with both abdominal and laparoscopic procedures were analyzed.

Results

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%. Three years after the first robotic procedure at hospitals where robotically assisted hysterectomy was performed, robotically assisted hysterectomy accounted for 22.4% of all hysterectomies. The rates of abdominal hysterectomy decreased both in hospitals where robotic-assisted hysterectomy was performed as well as in those where it was not performed. In a propensity score–matched analysis, the overall complication rates were similar for robotic-assisted and laparoscopic hysterectomy (5.5% vs 5.3%; relative risk [RR], 1.03; 95% CI, 0.86-1.24). Although patients who underwent a robotic-assisted hysterectomy were less likely to have a length of stay longer than 2 days (19.6% vs 24.9%; RR, 0.78, 95% CI, 0.67-0.92), transfusion requirements (1.4% vs 1.8%; RR, 0.80; 95% CI, 0.55-1.16) and the rate of discharge to a nursing facility (0.2% vs 0.3%; RR, 0.79; 95% CI, 0.35-1.76) were similar. Total costs associated with robotically assisted hysterectomy were $2189 (95% CI, $2030-$2349) more per case than for laparoscopic hysterectomy.

Conclusions and Relevance

Between 2007 and 2010, the use of robotically assisted hysterectomy for benign gynecologic disorders increased substantially. Robotically assisted and laparoscopic hysterectomy had similar morbidity profiles, but the use of robotic technology resulted in substantially more costs.

JAMA: Minimally Invasive/Robotic Surgery Topic Collection

Comparative Effectiveness Research on Robotic Surgery Comparative Effectiveness and Robotic Surgery

Robotically Assisted vs Laparoscopic Hysterectomy Among Women With Benign Gynecologic Disease Prevalence of Robotically Assisted Hysterectomy