Costs, complications increased with robotics for adnexal surgery

An analysis of data from nearly 90,000 women who underwent adnexal surgery over a 3-year period shows that robotically assisted procedures were associated with substantially higher costs and increases in intraoperative complications. The findings, published in Obstetrics & Gynecology, were from a population-based comparison of laparoscopic and robotically assisted procedures.

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Using a nationwide database, the researchers identified 87,514 women who had undergone adnexal surgery from 2009 to 2012. During that period, they found, use of robotic-assisted oophorectomy increased from 3.5% to 15% and robotically assisted cystectomy from 2.4% to 12.9%.

For robotically assisted versus laparoscopic oophorectomy, the overall complication rates were 7.1% and 6.0%, respectively (odds ratio [OR] 1.20, 95% CI 1.00-1.45, P=.052). The rate of intraoperative complications was higher when oophorectomy was robotically assisted (3.4% versus 2.1%, OR 1.60, 95% CI 1.21-2.13).

Looking at robotically assisted versus laparoscopic cystectomy, the authors found overall complication rates of 3.7% and 2.7%, respectively. The intraoperative complication rate was higher for the robotically assisted procedures (2.0% versus 0.9%, OR 2.40, 95% CI 1.31-4.38).

Comparing costs of robotic versus laparoscopic procedures, total costs for oophorectomy were $2,504 higher (95% CI $2,356-$2.652) and for cystectomy were $3,310 higher (95% CI $3,082-$3,581) with the robot.

During a period when use of robotically assisted adnexal surgery increased rapidly, the authors concluded, the technology was associated with substantially higher costs and a small but statistically significant increase in intraoperative complications compared with laparoscopy. 

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