Da Vinci Robotic Hysterectomy: Hype vs. Reality

Robotic hysterectomy for surgery has become more common over the past three years; however, experts are saying that it is more appropriately suited for complex conditions.  Dr. James Breeden, president of The American College of Obstetrics and Gynecologists (ACOG) released a statement reflecting the ACOG’s opinion about robotic surgery for hysterectomy:

“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.  Consequently, there is no good data proving that robotic hysterectomy is even as good as – let alone better – than existing, and far less costly, minimally invasive alternatives.”

A considerable amount of money has been spent on the marketing and advertising of this device by its manufacturers, and it appears to be effective.  According to a recent study, over the past three years, the number of robotic hysterectomies has increased approximately 10 percent.  Dr. Breeden boldly states that, “It is important to separate the marketing hype from reality when considering the best surgical approach for hysterectomy.”

Dr. Joel Weissman from Brigham and Women’s Hospital in Boston appears to agree with Dr. Breeden when he stated, “This is clearly in some ways a waste of resources…it’s a waste because there are equally good options and one is just more expensive than the other.”

Research conducted and led by Dr. Jason Wright from Columbia University in New York found a very minimal advantage of robotic surgery versus non-robotic:  instead of the standard 25 percent of women staying longer than two days after non-robotic surgery, only 20 percent stayed longer than two days after the robotic surgery.  In addition, they found no difference in a woman’s chances of requiring a blood transfusion or specialty care, based on the type of procedure (i.e. robotic or non-robotic surgery).

Second to cesarean sections, hysterectomies are the most common surgical procedure performed on women.  It’s obvious why manufacturers of the robotic device are pushing its use beyond complex hysterectomies.

According to Dr. Breeden, “…an estimated $960 million to $1.9 billion will be added to the health care system if robotic surgery is used for all hysterectomies each year.”  Dr. Wright and his team found that the average cost for a robotic-assisted hysterectomy was approximately $8,900, while non-robotic surgery costs approximately $6,700.

Any patient considering a hysterectomy should consult with their doctor regarding the various procedures available, their benefits and risks.  Any procedure of this type has associated risks, such as reaction to anesthesia, bleeding, infection, damage to other organs inside the abdomen, blood clots, etc.  However, patients should be aware of a risk specifically associated with use of the robotic device:  robotic surgeries generally take longer, meaning that the patient is under anesthesia longer, increasing other risks.

The use of an expensive robot that does not have any proven benefits for standard hysterectomies appears to simply be a money-making scheme and patients should fully investigate their options prior to surgery.

SOURCES:

http://www.reuters.com/article/2013/02/19/us-robot-hysterectomies-idUSBRE91I18I20130219

http://www.allinahealth.org/ahs/healthday.nsf/newsByID/674473

http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gynecology/robotic_hysterectomy_135,12/

http://www.foxnews.com/health/2013/03/15/ob-gyns-told-robot-hysterectomy-not-best-option/