Comparison of Robotic and Laparoscopic Hysterectomy for Benign Gynecologic Disease

Abstract

Objective Utilization of robotically assisted hysterectomy for benign gynecologic conditions is increasing. Using the most recent, available nationwide data, we examined clinical outcomes, safety, and cost of robotic compared to laparoscopic hysterectomy. Methods Women undergoing robotic or laparoscopic hysterectomy for benign disease were identified from the United States 2009 and 2010 Nationwide Inpatient Sample. Propensity scores derived from a logistic regression model were used to assemble matched cohorts of patients undergoing robotic and laparoscopic hysterectomy. Differences in in-hospital complications, hospital length of stay, and hospital charges were assessed between the matched groups. Results Of the 804,551 hysterectomies for benign conditions performed in 2009 and 2010, 20.6% were laparoscopic and 5.1% robotically-assisted. Among minimally invasive hysterectomies, the use of robotic hysterectomy increased from 9.5% to 13.6% (P=0.002). In a propensity-matched analysis, the overall complication rates were similar between robotic and laparoscopic hysterectomy (8.80 vs. 8.85%; relative risk [RR], 0.99; 95% confidence interval [CI], 0.89 to 1.09; P=0.910). There was a lower incidence of blood transfusions in robotic cases (2.1% vs. 3.1%; P<0.001, but patients undergoing robotic hysterectomy were more likely to experience postoperative pneumonia (RR= 2.2; 95% CI, 1.24 to 3.78; P=0.005). The median cost of hospital care was $9788 (IQR, $7105-$12780) for RH and $7299 (IQR, $5650-$9583) for LH (P<0.001. Hospital costs were on average $2489 (95% CI, $2313 to $2664) higher for patients undergoing robotic hysterectomy. Conclusion The utilization of robotic hysterectomy has increased. Perioperative outcomes are similar between laparoscopic and robotic hysterectomy, but robotic cases cost substantially more.

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

“…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.…”

“…[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.…”

Learning curve of laparoscopic hysterectomy in a zonal hospital setting: a retrospective analysis of 102 cases operated by a single surgeon

“…The relatively slow acquisition of expertise in laparoscopic hysterectomy may be attributed to inadequate exposure and training during residency or lack of equipments or requisite individual skill. [9][10][11] Hysterectomies for benign indications include abdominal (TAH), vaginal (VH), laparoscopic-assisted vaginal (LAVH), total laparoscopic (TLH), laparoscopic supra cervical (LSH) and robotic-assisted (RH). Progressive introduction and training in newer minimally invasive surgical techniques (LAVH, TLH, LSH, and RH) have resulted in an overall reduction in the abdominal hysterectomy rate from 77 to 35.2%.…”

Laparoscopic hysterectomy; our experience

“…İlk laparoskopik histerektominin Reich tarafından 1989'da tanımlanmasına rağmen, 2003 yılında tüm histerektomilerin ancak %11'i laparoskopik olarak gerçekleştirilmiştir (1,3,4) . 2010 yılına kadar bu oran ancak %20-30'a kadar arttırılabilmiştir (2,5,6) . American Association of Gynecologic Laparoscopists (AAGL) ve American College of Obstetrician and Gynecologist (ACOG) ortak konsensus raporunda laparoskopik histerektominin standart yaklaşım olması gerektiği belirtilmiş olmasına rağmen, günü-müzde histerektomilerin yarıdan fazlası laparotomi ile yapılmaktadır (7,8) .…”