Celine Lönnerfors1, Petur Reynisson1, Jan Persson2. 1. Department of Obstetrics and Gynecology, Skåne University Hospital and Lund University, Lund, Sweden. 2. Department of Obstetrics and Gynecology, Skåne University Hospital and Lund University, Lund, Sweden. Electronic address: jan.persson@med.lu.se.
Abstract
STUDY OBJECTIVE: To investigate the hospital cost and short-term clinical outcome of traditional minimally invasive hysterectomy vs robot-assisted hysterectomy in women primarily not considered candidates for vaginal surgery. DESIGN: Randomized controlled trial (Canadian Task Force classification I). SETTING:University Hospital in Sweden. PATIENTS: One hundred twenty-two women with uterine size ≤ 16 gestational weeks scheduled to undergo minimally invasive hysterectomy because of benign disease. INTERVENTIONS:Robot-assisted hysterectomy or traditional vaginal or laparoscopic minimally invasive hysterectomy. MEASUREMENTS AND MAIN RESULTS: All women underwent surgery as randomized. There were no demographic differences between the 2 groups. Vaginal hysterectomy was possible in 41% in the traditional minimally invasive group, at a mean hospital cost of $4579 compared with $7059 for traditional laparoscopic hysterectomy. This was reflected in a mean hospital cost of $993 more per robotic-assisted hysterectomy than for traditional minimally invasive hysterectomy when the robot was a preexisting investment. This hospital cost increased by $1607 when including investments and cost of maintenance. A per-protocol subanalysis comparing laparoscopy and robotics demonstrated similar hospital cost when the robot was a preexisting investment ($7059 vs $7016). Robotic-assisted hysterectomy was associated with less blood loss and fewer postoperative complications. CONCLUSION: A similar hospital cost can be attained for laparoscopy and robotics when the robot is a preexisting investment. From the perspective of hospital costs, robotic-assisted hysterectomy is not advantageous for treating benign conditions when a vaginal approach is feasible in a high proportion of patients.
RCT Entities:
STUDY OBJECTIVE: To investigate the hospital cost and short-term clinical outcome of traditional minimally invasive hysterectomy vs robot-assisted hysterectomy in women primarily not considered candidates for vaginal surgery. DESIGN: Randomized controlled trial (Canadian Task Force classification I). SETTING: University Hospital in Sweden. PATIENTS: One hundred twenty-two women with uterine size ≤ 16 gestational weeks scheduled to undergo minimally invasive hysterectomy because of benign disease. INTERVENTIONS: Robot-assisted hysterectomy or traditional vaginal or laparoscopic minimally invasive hysterectomy. MEASUREMENTS AND MAIN RESULTS: All women underwent surgery as randomized. There were no demographic differences between the 2 groups. Vaginal hysterectomy was possible in 41% in the traditional minimally invasive group, at a mean hospital cost of $4579 compared with $7059 for traditional laparoscopic hysterectomy. This was reflected in a mean hospital cost of $993 more per robotic-assisted hysterectomy than for traditional minimally invasive hysterectomy when the robot was a preexisting investment. This hospital cost increased by $1607 when including investments and cost of maintenance. A per-protocol subanalysis comparing laparoscopy and robotics demonstrated similar hospital cost when the robot was a preexisting investment ($7059 vs $7016). Robotic-assisted hysterectomy was associated with less blood loss and fewer postoperative complications. CONCLUSION: A similar hospital cost can be attained for laparoscopy and robotics when the robot is a preexisting investment. From the perspective of hospital costs, robotic-assisted hysterectomy is not advantageous for treating benign conditions when a vaginal approach is feasible in a high proportion of patients.
Authors: Benjamin B Albright; Tilman Witte; Alena N Tofte; Jeremy Chou; Jonathan D Black; Vrunda B Desai; Elisabeth A Erekson Journal: J Minim Invasive Gynecol Date: 2015-08-10 Impact factor: 4.137
Authors: Joshua A Boys; Evan T Alicuben; Michael J DeMeester; Stephanie G Worrell; Daniel S Oh; Jeffrey A Hagen; Steven R DeMeester Journal: Surg Endosc Date: 2015-07-15 Impact factor: 4.584
Authors: Gaby N Moawad; Elias D Abi Khalil; Paul Tyan; Michael K Shu; David Samuel; Richard Amdur; Stacey A Scheib; Cherie Q Marfori Journal: J Robot Surg Date: 2017-01-31
Authors: Sarah E Rutstein; Matthew T Siedhoff; Elizabeth J Geller; Kemi M Doll; Jennifer M Wu; Daniel L Clarke-Pearson; Stephanie B Wheeler Journal: J Minim Invasive Gynecol Date: 2015-10-22 Impact factor: 4.137