Robotic Hysterectomy Offers No Benefits Over Laparascopic Hysterectomy

The use of robotically assisted hysterectomy for women with benign gynecological disease offers little short-term benefit and has significantly greater costs than laparoscopic hysterectomy, according to the results of a large US cohort study.¹
   
In the United States, approximately 11% of women will undergo a hysterectomy because of benign gynecological disease in their lifetime. Although there are other minimally invasive approaches to hysterectomy, such as vaginal and laparoscopic hysterectomies, robotically assisted hysterectomy has been introduced as an alternative minimally invasive procedure. The potential benefits of robotic surgery are an increased range of motion, 3-dimensional stereoscopic visualization, and improved ergonomics for the operating surgeon, explain the study authors. One important concern, however, is that robotic surgery is associated with substantial costs.
   
Smaller studies have shown that robotic surgery is not associated with improved effectiveness or safety.² To better understand how well the procedure has been incorporated into clinical practice and how well it compares with laparoscopic hysterectomy in terms of complication profiles, the study authors analyzed data from 264,758 women who underwent hysterectomy for a benign gynecological condition at 441 hospitals across the United States between 2007 and 2010.
   
Robotic technology was used in 9.5% of all hysterectomies in 2010, up from 0.5% in 2007. The rate of use of laparoscopic hysterectomy also increased during this period, from 24.3% in 2007 to 30.5% in 2010. In hospitals in which robotic technology is available, 22.4% of all hysterectomies were robotically assisted. Correspondingly, the rates of abdominal hysterectomy have decreased within this period.
   
For hysterectomies, robotic surgery had no benefit over laparoscopic surgery in terms of overall complication rates (5.5% vs 5.3%, respectively). Women who underwent robotically assisted hysterectomy were more likely to have a shorter length of hospital stay (2 days or less) than women who had a laparoscopic hysterectomy (80.4% vs 75.1%, respectively), but the need for transfusion and the rates of discharge to a nursing facility were similar between groups (1.4% robotic vs 1.8% laparoscopic and 0.2% robotic vs 0.3% laparoscopic, respectively). In addition, robotically assisted hysterectomy had higher associated costs, averaging $2189 more per surgery than laparoscopic hysterectomy.
   
According to the study authors, these findings “highlight the importance of developing rational strategies to implement new surgical technologies.” Because there are already minimally invasive alternatives to robotic surgery for hysterectomy that offer similar outcomes, there is little justification for the additional cost of using robotic technology for this clinical purpose, concluded the study authors.

Pertinent Points:
- There has been a substantial increase in the number of robotically assisted hysterectomies for benign gynecological disorders.
- The available evidence shows that robotic hysterectomy offers little benefit in terms of outcomes over laparoscopic hysterectomy, making it difficult to justify the additional cost of using robotic technology.
 

References:

1. Wright JD, Ananth CV, Lewin SN, et al. Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease. JAMA. 2013;309:689-698.
2. Liu H, Lu D, Wang L, et al. Robotic surgery for benign gynecological disease. Cochrane Database Syst Rev. 2012;2:CD008978.