Use of the Robot for Adnexal Surgery May Not Be Best

October 18, 2014

New research looking at complication rates and cost for oophorectomy and cystectomy favors conventional laparoscopy over robotic surgery.

The cost was higher and complications were more likely with robotically assisted adnexal surgery, when compared with laparoscopic surgery.

Researchers at Columbia University Medical Center found that robot-assisted surgery for oophorectomy and cystectomy for benign disease may not be better than the conventional laparoscopic surgical techniques. The results of the latest study were published online in Obstetrics & Gynecology.

Even as the use of robot-assisted surgeries has increased significantly over the past several years, the researchers found that complications during surgery have persisted. The study showed a statistically significant overall increase in intraoperative complications, consisting of mainly of ureteral and bladder injuries, when surgeons performed the procedures using a robot.

Pertinent Points
- Robot-assisted adnexal surgeries were more expensive than the conventional laparoscopic surgeries and led to more complications.

- The most common complications involved ureteral and bladder injuries.

For oophorectomies, the rate of complications was 3.4% for robot-assisted cases, compared with 2.1% for those performed laparoscopically. With cystectomies, the robotic surgeries had a complication rate of 2%, compared with 0.9% for laparoscopic surgeries.

"The findings raise questions about the potential utility of robotic-assisted surgery for ovarian cancer and suggest that further studies are needed prior to considering these procedures as a standard of care," said co-author Jason Wright, MD, Sol Goldman Associate Professor of Gynecologic Oncology and chief, Division of Gynecologic Oncology, Columbia University College of Physicians and Surgeons.

Equally alarming is the significant cost increase associated with performing the same surgery using a robot. The median total cost for robot-assisted oophorectomy was $7,426, while for conventional laparoscopic oophorectomy it was $4,922. That’s a 51% cost increase. Even more astounding was the difference in costs for cystectomy, with robot-assisted surgery costing 80% more.

"With the rapid rise in the cost of cancer care, we need to make sure that public policies encourage comparative studies prior to widespread dissemination of new technologies," said another co-author, Dawn L. Hershman, MD, MS, associate professor of medicine at the College of Physicians and Surgeons, associate professor of epidemiology at Columbia's Mailman School of Public Health, and leader of the Breast Cancer Program at the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian/Columbia.

The researchers relied on a nationwide database to look at 87,514 women who had surgeries performed between 2009 and 2012.