Study Challenges Benefits of Robotic-Assisted Laparoscopic Hysterectomy

A recent study may make proving medical necessity for robotic-assisted laparoscopic hysterectomy surgery more of a challenge. A retrospective review of 36,188 patient records from 358 hospitals found the robot-assisted hysterectomy procedure costs thousands of dollars more than traditional laparoscopic hysterectomy surgery with no significant improvement in clinical outcomes. Surgery time also was significantly less for non-robotic-assisted procedures.

“Robot-assisted surgery can provide advancement in minimally invasive procedures for a very select, more complex type of procedure, such as laparoscopic prostatectomy or gynecologic oncology,” said Resad P. Pasic, M.D., Ph.D., University of Louisville, Ky., one of the lead investigators for the study. “However, our study showed that in routine hysterectomy procedures, where traditional laparoscopic approaches can achieve the same clinical outcomes at a much lower cost to hospitals and with shorter operating time, there is no value proposition to use the robot for routine hysterectomy.”

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The study examined data from the Premier hospital database of cases involving women 18 years or older who had a minimally invasive hysterectomy — traditional or robot-assisted — performed between 2007 and 2008, according to a Johnson & Johnson press release.

The results of the study, titled “Comparing Robot-Assisted to Conventional Laparoscopic Hysterectomy: Impact on Cost and Clinical Outcomes,” was sponsored by Ethicon Endo-Surgery and e-published in the October issue of the Journal of Minimally Invasive Gynecology.

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4 Responses to “Study Challenges Benefits of Robotic-Assisted Laparoscopic Hysterectomy”

  1. Stephanie Jones says:

    I believe the robot assisted hysterectomy is indeed worth the money. I had the surgery on a Friday, and was back to work full time the following Wednesday. This is so much less invasive, and the recovery time is much less than with a traditional hysterectomy. For those of us whom have little sick or vacation time to take because of kids’ appointments, or our own appointments that use up our sick and vacation time, the robotic hysterectomy is the only way to be able to have the procedure done and be back to work quickly.

    Sincerely,
    Stephanie Jones

  2. S. Badalamenti says:

    I’ve had numerous surgeries from Open, laparoscopic to robotic assisted surgeries. From my experience, robotic surgery is way to go. Yes, it maybe more costly but the benefit to the patient out ways the cost. Patients only loses few tablespoons of blood rather then pints of blood, which has lower chance of patient having blood transfusions and other complications. Also there is less reason for incisional hernias (which I had with laparoscopic surgery) with robotic surgery since the Dr. only needs to cut a centimeter rather then many inches. There are less chance of infection as well. With robotic surgery, patients recover at about 75% faster then laparoscopic, right there is a reason enough for Drs. to perform robotic then the traditional route. Most beneficial to the patient is the pain level, they only need to take strong pain medicine for only for few days if any, vs. the traditional method would be for many weeks to months. Patients can get back to their “normal” schedule within a week or so vs. months. Surprisingly, robotic hands are more accurate then human hands with less “fatigue”. Many Drs.. choose not to do robotic surgery because they do not want to spend the money or the time to learn the new method, which would help their patients tremendously. It would be interesting to know who funded the study, perhaps the insurance companies?

  3. Dal Harrison says:

    the study was sponsored by Ethicon Endo-Surgery which is a subsidiary of Johnson & Johnson, not an insurance company. The link to the press release which has more information about the retrospective review.

  4. A Chamberlain says:

    The fact is that the majority of hysterectomies are still done using traditional, big incision, long and painful recovery “open” techniques. The reason is that most surgeons haven’t or can’t acquire the advanced laparoscopic skills necessary to perform Total Laparoscopic Hysterectomy (TLH) safely. LAVH has been available for over a decade, but adoption has been relatively slow.

    Robotic Hysterectomy is much easier, faster and safer to learn than Total Laparoscopic Hysterectomy. As a result, the real choice is Robotic Hysterectomy vs. Total Abdominal Hysterectomy, not Robotic vs. Laparoscopic Hysterectomy. Everyone agrees that Robotic Hysterectomy is clearly superior to traditional TAH. It is not surprising that the number of Robotic Hysterectomies has been skyrocketing.

    The study described was sponsored by Ethicon, a company that produces few Robotic Instruments. I am skeptical that the cost analyses they propose capture the remarkable difference in how patients feel post-op from Robotic Hysterectomy vs. Traditional LAVH or Total Laparoscopic Hysterectomy. No one in our Gynecology group has done an “Open” hysterectomy this year, and all of our advanced laparoscopic surgeons have switched from TLH to Robotic Hysterectomy simply because the patients do better.

    This is a fight that has been fought and won by Robotics. It is time Ethicon got on board.

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