A population-based analysis comparing laparoscopic hysterectomy and robotic hysterectomy for endometrial cancer “found similar morbidity but increased cost compared with laparoscopic hysterectomy,” investigators reported in the Journal of Clinical Oncology.1 After adjusting for patient, surgeon, and hospital characteristics, the investigators found no significant differences between the two procedures in the rates of intraoperative complications, surgical site complications, medical complications, or prolonged hospitalization.
“The mean cost for robotic hysterectomy was $10,618 vs $8,996 for laparoscopic hysterectomy (P < .001). In a multivariable model, robotic hysterectomy was significantly more costly,” the investigators reported. They concluded that comparative long-term efficacy data are needed to justify the widespread use of robotic hysterectomy.
Rapid Uptake of Robotic Procedure
Of the 2,464 women in the study database, 1,027 (41.7%) underwent laparoscopic hysterectomy and 1,437 (58.3%) underwent robotic hysterectomy. “Use of robotic surgery increased with time,” the authors noted, going from 46.2% of the minimally invasive hysterectomies for endometrial cancer in 2008 to 61.1% in 2010. “Despite the rapid uptake of robotic hysterectomy, there seems to be little short-term benefit for the procedure. Compared with laparoscopic hysterectomy, robotic procedures are associated with substantially greater direct hospital costs,” the authors concluded. “Our findings highlight the potential pitfalls of the rapid uptake of new technology before the availability of rigorous data to demonstrate efficacy and cost-effectiveness.” ■
1. Wright JD, Burke WM, Wilde ET, et al: Comparative effectiveness of robotic versus laparoscopic hysterectomy for endometrial cancer. J Clin Oncol. January 30, 2012 (early release online).