Roger That!

Posted by The Evidence Blog on March 28, 2013

We hate to say we were right…but we were!

For the past few weeks we’ve been blogging about the claimed advantages of robotic surgery for hysterectomy, and reminding everyone that robotic surgery is not the only or the best minimally invasive approach for hysterectomy. Nor is it the most cost-efficient.

(We've been tracking the evidence on robotic hysterectomies for some time; click for your FREE Pocket Evidence Summary.)

First we reported on a JAMA study, which found that the percentage of robotic hysterectomies has jumped from less than 0.5% to nearly 10% over the past 3 years. A study of more than 264,000 hysterectomy patients in 441 hospitals also found that robotics added an average of $2000 per procedure without any demonstrable benefit.

In recent weeks, Massachusetts health officials have sent hospitals an “advisory letter” alerting them about their safety concerns regarding robotic hysterectomies. In some cases, it appeared that surgeons were using the robots to perform hysterectomies that were too complex for the technology or for the surgeons’ skill level in directing the robots.

And now the American Congress of Obstetricians and Gynecologists (ACOG) has come out with a statement of its own. “While there may be some advantages to the use of robotics in complex hysterectomies, especially for cancer operations that require extensive surgery and removal of lymph nodes, studies have shown that adding this expensive technology for routine surgical care does not improve patient outcomes.“

The ACOG statement makes another interesting point, as well. The outcome of any surgery is directly associated with the surgeon’s skill, which is achieved only after many years of training and experience. Studies show there is a learning curve with new surgical technologies, during which there is an increased complication rate. Expertise with robotic hysterectomy is limited and varies widely among both hospitals and surgeons, providing little data to support the fact that for uncomplicated hysterectomies, robotic surgery is equal to—let alone better than—existing and less costly minimally invasive alternatives.

According to the ACOG, vaginal hysterectomy is the least invasive and least expensive option and should be the procedure of choice whenever technically feasible in uncomplicated cases. When this approach is not possible, laparoscopic hysterectomy is the second least invasive and costly option for patients. Robotic hysterectomy is probably best saved for unusual and complex clinical conditions in which improved outcomes over standard minimally invasive approaches have been demonstrated.

At a time when there is a demand for more fiscal responsibility and transparency in healthcare, the use of expensive medical technology should be questioned when less-costly alternatives provide equal or better patient outcomes. Hysterectomy is one of the most common major surgeries in the U.S. and costs the U.S. healthcare system more than $5 billion a year.

Consider this: if robotic surgery was used for all hysterectomies, an estimated $960 to $1.9 billion would be added to the healthcare system. That’s a great deal of money to spend on a procedure that is more expensive and no more effective than other, less costly and readily available alternative surgical approaches.

(We've been tracking the evidence on robotic hysterectomies for some time; click for your FREE Pocket Evidence Summary.)

Topics: Hayes Blog

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