Robotic Hysterectomy: Procedures Increasing, But Questions Remain

Article preview from Medtech Insight - March 27, 2013

Controversy continues to swirl around robotic surgical procedures and this time the target is robotic hysterectomy. However, the drama does not seem to be impacting the number of these procedures performed robotically, a statistic that is clearly on the rise.

Robotic Hysterectomy: Procedures Increasing, But Questions Remain

Article preview from Medtech Insight - March 27, 2013

The US has the highest rate of hysterectomy in the industrialized world, and according to the Centers for Disease Control & Prevention, it is the second most frequently performed surgical procedure in women (after Cesarean section). Approximately 600,000 hysterectomies are performed annually in the US, with the vast majority for noncancerous conditions such as menorrhagia. The total number of procedures has been on a gradual decline over the last several years; however, the number of cases performed minimally invasively and robotically is going up. Robotic-assisted hysterectomy using the only US Food and Drug Administration-approved system, the da Vinci Surgical System from Intuitive Surgical Inc., was performed in approximately 176,000 patients in 2012, up from about 140,000 cases in 2011, according to the company. However, controversies persist with robotic technology, and the results of a new study cite the potential higher costs of robotics.

According to the results of a large cohort study published February 20 in the Journal of the American Medical Association, while da Vinci hysterectomy (dVH) clinical results are equivalent to nonrobotic laparoscopic hysterectomy for women with benign disease, the cost of the robotic procedure is higher. The study analyzed inpatient data from Premier on perioperative morbidity, mortality, and resource utilization from 264,758 women (with coding data extrapolated from a smaller sample size) who underwent hysterectomy for benign gynecologic disorders at 441 US hospitals from 2007 through the first quarter of 2010. Over this period, dVH increased from 0.5% of all hysterectomies in 2007 to 9.5% of all hysterectomies in 2010, and at the same time, laparoscopic hysterectomy rates increased from 24.3% to 30.5%. Overall hysterectomy rates (via laparotomy, vaginally or by laparoscopy) decreased both in hospitals where dVH was performed as well as in those where it was not performed: from 53.6% in 2007 to 40.1% in 2010 (attributable to the increased use of alternative therapies for menorrhagia). The overall complication rates were similar for dVH and laparoscopic hysterectomy (5.5% versus 5.3%), and patients who underwent dVH were less likely to have a length of stay longer than two days (19.6% versus 24.9%). However, the study also found that the total costs associated with dVH were $2,189 higher per case than for laparoscopic hysterectomy: $6,679 for laparoscopic hysterectomy compared with $8,868 for dVH.

It should be noted that the study didn't break out surgically complicated cases, and Intuitive has stated that robotic-assisted hysterectomy primarily addresses a more complicated subset of benign cases, which would be very difficult or impossible to perform via conventional laparoscopy. In response to the study, Intuitive's chief medical advisor, Myriam Curet, MD, told Medtech Insight that robotics help avoid the high costs associated with open surgery. "There are still many cases that remain open procedures due to the surgical complexities of certain patients, including uterus size, high body mass index, scarring from previous surgeries, and multiple Cesarean sections, to name just a few," she says. "As a tool, robotic surgery helps surgeons overcome the limitations of traditional minimally invasive techniques to provide patients with a less invasive option and prevent the downstream costs and complications of an open procedure."

Continued...

To read this article in its entirety, purchase now, as a PDF and recieve it immediately via email. Or get it free when you subscribe to Medtech Insight Newsletter.

About Medtech Insight

Medtech Insight newsletter provides insights into the technology and market developments (devices, instrumentation, biomaterials, gene therapy, tissue engineering, etc) impacting a wide range of surgical and non-surgical clinical practices.