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Study: No added benefit for hysterectomies with robotics

Surgical system like this one are the only

Surgical system like this one are the only general surgery devices used in U.S. hospitals. Credit: AP, 2011

Robotic surgery for routine hysterectomies provides no added benefit compared with another widely used procedure but costs more and increases the size of patients' hospital bills, researchers report Wednesday.

In the largest study of its kind, investigators at Columbia University Medical Center in Manhattan found robotically performed hysterectomies escalated hospital bills by more than $2,000.

Doctors compared hysterectomies performed robotically to camera-aided laparoscopy, another minimally invasive procedure.

Dr. Jason Wright, who analyzed the cases of 264,758 women who underwent hysterectomies at 441 hospitals nationwide, said women were billed $8,668, on average, for the robotic technique but only $6,679 for laparoscopy.

Robotic procedures allow the surgeon to work from a console and manipulate an array of robotic arms. A camera allows a close-up view of the operation, which is conducted through a small incision.

A laparoscopic hysterectomy is also a small-incision technique that allows the physician to see the surgical field with the aid of a camera.

Both are noteworthy because they do not cause significant pain and allow patients to leave the hospital after only a brief stay.

"When we compared these two modalities there was no difference between them other than the robotic procedure being substantially more expensive," Wright said.

A hysterectomy refers to the removal of the uterus and, in some instances, other pelvic structures, such as the fallopian tubes and ovaries.

Researchers studied the two procedures when hysterectomies were recommended for common, noncancerous conditions, such as uterine fibroids, benign, abnormal growths occurring in the uterine wall; or, endometriosis, an excruciatingly painful condition in which tissue lining the uterus becomes deposited on the ovaries or elsewhere in the pelvic region, bleeding in synchrony with monthly hormonal cycling.

The U.S. Food and Drug Administration approved robotically performed hysterectomies in 2005.

Wright's study covered surgeries performed between 2007 and 2010, and found robotically assisted hysterectomies increased during the study period from 0.5 percent of procedures in 2007 to nearly 10 percent by 2010.

The number of laparoscopic hysterectomies also increased, according to the study, published Wednesday in the Journal of the American Medical Association, accounting for 24.3 percent of the procedures in 2007 and 30.5 percent by 2010.

About 600,000 hysterectomies are performed annually in the United States, Wright said, making it the most commonly performed surgical procedure for nonmalignant, female pelvic conditions.

An estimated 1 in 9 women, he added, will undergo the operation during her lifetime.

In an accompanying editorial, Drs. Joel Weissman and Michael Zinner of Brigham and Women's Hospital in Boston say robotically performed hysterectomies raise a host of questions.

"Would it be a better use of resources to train more surgeons in laparoscopic techniques than to spend the money on more robot machines," they asked.

The da Vinci Surgical Systems manufactured by Intuitive Surgical Inc., are the only general surgery devices used in U.S. hospitals. The devices are joystick- and foot pedal-controlled and cost about $1.5 million.They are also used in heart and prostate surgeries.

Dr. Ann Buhl, director of gynecologic oncology at South Nassau Communities Hospital in Oceanside calls the device a godsend for cancer surgery.

"It's three-dimensional technology. It's phenomenal," she said. "The arms move exactly like your hands. It's great for us because we can do more."

"With laparoscopy someone has to hold the camera and they have to guide it as you work; they have to follow you and that makes it a lot more difficult," she said.


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