A systematic review and cost analysis of robot-assisted hysterectomy in malignant and benign conditions

Tapper, Anna‐Maija; Hannola, Mikko; Zeitlin, Rainer; Isojärvi, Jaana; Sintonen, Harri; Ikonen, Tuija

doi:10.1016/j.ejogrb.2014.03.010

Cited by 61 publications

(50 citation statements)

References 46 publications

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“…Similar to Tapper et al in 2014 (6), our previous results presented robotic surgery as safe and useful (7), further allowing us to enlarge the indication for robotic surgery. Its feasibility was demonstrated in functional and oncological surgeries (8).…”

Section: Introductionsupporting

confidence: 82%

Pedagogic Approach in the Surgical Learning: The First Period of “Assistant Surgeon” May Improve the Learning Curve for Laparoscopic Robotic-Assisted Hysterectomy

et al. 2016

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BackgroundHysterectomy is the most frequent surgery done with robotic assistance in the world and has been widely studied since its emergence. The surgical outcomes of the robotic hysterectomy are similar to those obtained with other minimally invasive hysterectomy techniques (laparoscopic and vaginal) and appear as a promising surgical technique in gynecology surgery. The aim of this study was to observe the learning curve of robot-assisted hysterectomy in a French surgical center, and was to evaluate the impact of the surgical mentoring.MethodsWe retrospectively collected the data from the files of the robot-assisted hysterectomies with the Da Vinci® Surgical System performed between March 2010 and June 2014 at the Foch hospital in Suresnes (France). We first studied the operative time according to the number of cases, independently of the surgeon to determine two periods: the initial learning phase (Phase 1) and the control of surgical skills phase (Phase 2). The phase was defined by mastering the basic surgical tasks. Secondarily, we compared these two periods for operative time, blood losses, body mass index (BMI), days of hospitalizations, and uterine weight. We, finally, studied the difference of the learning curve between an experimented surgeon (S1) who practiced first the robot-assisted hysterectomies and a less experimented surgeon (S2) who first assisted S1 and then operated on his own patients.ResultsA total of 154 robot-assisted hysterectomies were analyzed. Twenty procedures were necessary to access to the control of surgical skills phase. There was a significant decrease of the operative time between the learning phase (156.8 min) compared to the control of surgical skills phase (125.8 min, p = 0.003). No difference between these two periods for blood losses, BMI, days of hospitalizations and uterine weight was demonstrated. The learning curve of S1 showed 20 procedures to master the robot-assisted hysterectomies with a significant decrease of the operative time, while the learning curve of S2 showed no improvement in operative time with respect to case number.ConclusionTwenty robot-assisted hysterectomies are necessary to achieve control of surgical skills. The companionship to learn robotic surgery seems also promising, by improving the learning phase for this surgical technique.

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Section: Introductionsupporting

confidence: 82%

Pedagogic Approach in the Surgical Learning: The First Period of “Assistant Surgeon” May Improve the Learning Curve for Laparoscopic Robotic-Assisted Hysterectomy

et al. 2016

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“…Our results regarding cost are consistent with published data showing significantly increased costs with robotic-assisted hysterectomy. 4,8–12 As surgeons, we have an obligation to consider the cost-benefit ratio of our interventions and balance our goals of optimizing clinical outcomes and practicing good stewardship of our healthcare resources.…”

Section: Commentmentioning

confidence: 99%

“…3–7 Although cited benefits of the robotic-assisted route over conventional laparoscopy include lower estimated blood loss and shorter length of stay, complication rates appear to be similar and costs significantly higher with robotic technology. 4,8–12 Vaginal hysterectomy remains the preferred route when possible and is recommended as such by the American Congress of Obstetricians and Gynecologists. 13 However, few comparative studies of robotic hysterectomy actually include vaginal approaches.…”

Section: Introductionmentioning

confidence: 99%

Comparison of robotic and other minimally invasive routes of hysterectomy for benign indications

Swenson

Kamdar

Harris

et al. 2016

American Journal of Obstetrics and Gynecology

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Background Despite a lack of evidence showing improved clinical outcomes with robotic-assisted hysterectomy over other minimally-invasive routes for benign indications, this route has increased in popularity over the last decade. Objective Compare clinical outcomes and estimated cost of robotic-assisted versus other routes of minimally-invasive hysterectomy for benign indications. Study Design A statewide database was used to analyze utilization and outcomes of minimally-invasive hysterectomy performed for benign indications from January 1, 2013 – July 1, 2014. A one-to-one propensity score-match analysis was performed between women who had a hysterectomy with robotic assistance versus other minimally-invasive routes (laparoscopic and vaginal, with or without laparoscopy). Perioperative outcomes, intraoperative bowel and bladder injury, 30-day postoperative complications, readmissions, and reoperations were compared. Cost estimates of hysterectomy routes, surgical site infection, and postoperative blood transfusion were derived from published data. Results 8,313 hysterectomy cases were identified: 4,527 performed using robotic-assistance and 3,786 performed using other minimally-invasive routes. 1,338 women from each group were successfully matched using propensity score-matching. Robotic-assisted hysterectomies had lower estimated blood loss (94.2 ±124.3 vs. 175.3 ±198.9 mL, p <.001), longer surgical time (2.3 ± 1.0 vs 2.0 ± 1.0 hours, p<.001), larger specimen weights (178.9 ± 186.3 vs 160.5 ± 190 g, p =.007) and shorter length of stay (14.1% (189) vs 21.9% (293) ≥ 2 days, p<.001). Overall, the rate of any postoperative complication was lower with the robotic-assisted route (3.5% (47) vs 5.6% (75), p=.01) and driven by lower rates of superficial SSI (0.07% (1) vs 0.7% (9), p =.01) and blood transfusion (0.8% (11) vs 1.9% (25), p=.02). Major postoperative complications, intraoperative bowel and bladder injury, readmissions, and reoperations were similar between groups. Using hospital cost estimates of hysterectomy routes and considering the incremental costs associated with surgical site infections and blood transfusions, non-robotic minimally-invasive routes had an average net savings of $3,269 per case, or 24% lower cost, compared to robotic-assisted hysterectomy ($10, 160 vs $13,429). Conclusions Robotic-assisted laparoscopy does not decrease major morbidity following hysterectomy for benign indications when compared to other minimally-invasive routes. While superficial surgical site infection and blood transfusion rates were statistically lower in the robotic-assisted group, in the absence of substantial reductions in clinically and financially burdensome complications, it will be challenging to find a scenario in which robotic-assisted hysterectomy is clinically superior and cost-effective.

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“…Our results regarding cost are consistent with published data showing significantly increased costs with robotic-assisted hysterectomy. 4,[8][9][10][11][12] As surgeons, we have an obligation to consider the cost-benefit ratio of our interventions and balance our goals of optimizing clinical outcomes and practicing good stewardship of our healthcare resources.…”

Section: Commentmentioning

confidence: 99%

“…[3][4][5][6][7] Although cited benefits of the robotic-assisted route over conventional laparoscopy include lower estimated blood loss and shorter length of stay, complication rates appear to be similar and costs significantly higher with robotic technology. 4,[8][9][10][11][12] Vaginal hysterectomy remains the preferred route when possible and is recommended as such by the American Congress of Obstetricians and Gynecologists. 13 However, few comparative studies of robotic hysterectomy actually include vaginal approaches.…”

Section: Introductionmentioning

confidence: 99%

6: Comparison of robotic and other minimally-invasive routes of hysterectomy for benign indications

Swenson

Kamdar

Morgan

2016

American Journal of Obstetrics and Gynecology

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A systematic review and cost analysis of robot-assisted hysterectomy in malignant and benign conditions

Cited by 61 publications

References 46 publications

Pedagogic Approach in the Surgical Learning: The First Period of “Assistant Surgeon” May Improve the Learning Curve for Laparoscopic Robotic-Assisted Hysterectomy

Pedagogic Approach in the Surgical Learning: The First Period of “Assistant Surgeon” May Improve the Learning Curve for Laparoscopic Robotic-Assisted Hysterectomy

Comparison of robotic and other minimally invasive routes of hysterectomy for benign indications

6: Comparison of robotic and other minimally-invasive routes of hysterectomy for benign indications

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