The clinical and financial impact of introducing robotic‐assisted hysterectomy in a tertiary referral centre: A direct cost analysis of consecutive hysterectomies during a decade

Abstract

Background: Economic data and the clinical impact of introducing robotic-assisted hysterectomy in a European setting are scarce with conflicting findings. Methods:In this retrospective cohort study, the cost and complication rate of the different approaches of hysterectomy are investigated, both benign and (pre)malignant indications were included.Results: 844 patients were included: 323 (38.3%) patients underwent roboticassisted hysterectomy (RAH), 317 (37.5%) total abdominal hysterectomy (TAH), and 204 (24.2%) total laparoscopic hysterectomy (TLH). TAH dropped from 67.2% to 25.5% of procedures, whilst RAH rose to 41.8% of cases. The total hospitalisation cost was for RAH €5208.39 (�€916.91), for TAH €5846.61 (�€4464.37) and for TLH €3790.06 (�€1267.05). The postoperative complication rate of TAH (9.1%) was significantly higher in comparison with TLH and RAH (5.4% and 3.1%, respectively, p = 0.005).Conclusions: RAH has replaced TAH in most cases, especially for large uteri, earlystage endometrial cancer and in selected endometriosis cases, resulting in reduced morbidity with lower hospitalisation costs. The indications for TLH remained, including menorrhagia, adenomyosis and persistent cervical dysplasia.

Laparoscopy with transverse-abdominal extra-fascial hysterectomy for early-stage endometrial carcinoma, obesity, and large uterus: A case report

“…[7] Nowadays, total abdominal hysterectomy in patients is mainly performed in those endometrial carcinoma patients with large uterus and obesity, while may be challenging because of limited visibility and wound complications. Robot-assisted laparoscopy surgery is more commonly applied in those patients, [8][9][10] with the obvious advantages of good visual field exposure, minimal invasion, and rapid recovery. [11][12][13] Akiyo Kakibuchi had reported robot-assisted laparoscopic hysterectomy for early-stage endometrial cancer with massive uterine leiomyomas and significantly fewer intra-and post-operative complications.…”