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Robotic Assisted Hysterectomy Associated With No Greater Benefit Than Laparoscopic Procedure But Costs Significantly More

INTRO: Each year in the United States thousands of women undergo a hysterectomy for non-cancer-related gynecological disorders. Many of these procedures are performed using minimally invasive techniques including laparoscopy and with the assistance of a surgical robotic platform.  A new study examined the complication rates of these surgeries, the cost and how often the procedures were being performed. Catherine Dolf explains in this week’s JAMA Report.

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Women walking on street, laparoscopic and robotic assisted surgery

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ONE IN NINE WOMEN IN THE UNITED STATES WILL UNDERGO A HYSTERECTOMY DURING HER LIFETIME. SURGICAL INNOVATION HAS PRODUCED MINIMALLY INVASIVE TECHNIQUES FOR HYSTERECTOMY LIKE LAPAROSCOPY AND IN THE LAST FEW YEARS THE USE OF ROBOTIC ASSISTED SURGERY.  BOTH ARE SIMILAR OPERATIONS.

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SOT/FULL Super @:15 Jason D. Wright, M.D., – Columbia University College of Physicians and Surgeons Runs:11

“The instrumentation is put in through small incisions that are called ports. In a robotic hysterectomy a surgical robot is attached to the instruments that go into these ports.”

(Video covering 2nd half of bite: robotic assisted surgery)

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SOT/FULL Super @:27 Dawn L. Hershman, M.D., – Columbia University College of Physicians and Surgeons Runs:13

“It’s really important for us to know what settings that new technologies should be used cause they have a real benefit and in what settings they don’t have as big of a benefit.”

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Dr. Wright and Dr. Hershman walking, standing and talking, women walking, laparoscopic surgery

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DOCTORS JASON WRIGHT AND DAWN HERSHMAN FROM COLUMBIA UNIVERSITY COLLEGE OF PHYSICIANS AND SURGEONS AND CO-AUTHORS EXAMINED BOTH OF THESE OPERATIONS OVER A THREE YEAR PERIOD, FROM 2007 TO 2010. RESEARCHERS STUDIED MORE THAN 260 THOUSAND WOMEN WHO UNDERWENT A HYSTERECTOMY FOR NON-CANCER-RELATED GYNECOLOGICAL DISORDERS AT 441 HOSPITALS.

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SOT/FULL Super @:58 Jason D. Wright, M.D., – Columbia University College of Physicians and Surgeons Runs:07

“The use of robotic hysterectomy really increased rapidly between 2007 and 2010 in the United States.”

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SOT/FULL Super @1:04 Dawn L. Hershman, M.D., – Columbia University College of Physicians and Surgeons Runs:07

“By the end of 2010, 25 percent of hospitals that had a robot were using them for hysterectomies.”

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GXF FULL JAMA COVER

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THE STUDY APPEARS IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.

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SOT/FULL Super @1:16 Jason D. Wright, M.D., – Columbia University College of Physicians and Surgeons Runs:15

“There was really no difference in the complication rates and the outcomes between women who had a laparoscopic compared to a robotic hysterectomy. On average the cost of robotic hysterectomy was over 2200 dollars greater than laparoscopic hysterectomy.”

(Video covering middle of bite: laparoscopic and robotic assisted surgeries)

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Robotic and laparoscopic surgery

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SOME OF THAT INITIAL COST COMES FROM PURCHASING THE ROBOT ASSIST DEVICE.  HOWEVER, ONE OF THE CLAIMS FOR ROBOTIC ASSISTED SURGERY WAS THE MORE PROCEDURES DONE THE LOWER THE COST. RESEARCHERS FOUND LITTLE EVIDENCE THAT THIS COST DECREASED EVEN WITH SURGICAL EXPERIENCE.

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SOT FULL Super @1:44 Dawn L. Hershman, M.D., – Columbia University College of Physicians and Surgeons Runs:10

“Getting a laparoscopic hysterectomy is really not that different than getting a robotic hysterectomy and women can feel comfortable making that choice.”

(Video covering 2nd half of bite: women walking)

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Women walking

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CATHERINE DOLF, THE JAMA REPORT.

TAG:RESEARCHERS ALSO NOTED THAT AFRICAN-AMERICAN PATIENTS AND PATIENTS WITHOUT PRIVATE INSURANCE WERE LESS LIKELY TO UNDERGO A ROBOTIC ASSISTED OPERATION.