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Robotic Surgery for Hysterectomy Often Not Best Option, Ob/Gyn Group Says

Expensive procedure adds little to routine care and should be reserved for complex cases, experts say

FRIDAY, March 15 (HealthDay News) -- Despite claims to the contrary in "widespread marketing and advertising," expensive robotic surgery for hysterectomy is neither the only nor the best minimally invasive approach for the operation, according to a leading group representing obstetricians and gynecologists.

"It is important to separate the marketing hype from the reality when considering the best surgical approach for hysterectomies," Dr. James Breeden, president of the American College of Obstetricians and Gynecologists (ACOG), said in a statement released Thursday.

He said the least invasive and cheapest method is vaginal hysterectomy, which involves going through a small opening at the top of the vagina, without any abdominal incisions. This approach has a low complication rate and is the procedure of choice when possible, according to ACOG.

When vaginal hysterectomy is not possible, laparoscopic hysterectomy is the second least invasive and costly option, according to ACOG.

It's important that women understand the facts when making a decision about hysterectomy surgery, Breeden said.

"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," Breeden said.

Women who undergo robotic hysterectomy typically have less discomfort, shorter hospitalizations and make a full recovery faster than those who have traditional total abdominal hysterectomy (TAH), which requires a large incision.

However, both vaginal and laparoscopic hysterectomy also require fewer days of hospitalization and far shorter recovery than TAH, and these two methods also have proven track records for good patient outcomes and cost efficiency, according to Breeden.

"Patients should be advised that robotic hysterectomy is best used for unusual and complex clinical conditions in which improved outcomes over standard minimally invasive approaches have been demonstrated," Breeden said.

He noted that robotic hysterectomy is the most expensive method, with a price of more than $1.7 million per robot, $125,000 in annual maintenance costs, and up to $2,000 per surgery for the cost of single-use surgical instruments.

One recent study found that the percentage of hysterectomies performed robotically rose from less than 0.5 percent to nearly 10 percent over the past three years. Another study of more than 264,000 hysterectomy patients found that robotic surgery added an average of $2,000 per procedure without any proven benefit, Breeden said.

Hysterectomy -- removal of the uterus -- is one of the most common major surgeries in the United States and costs the nation's health care system more than $5 billion a year.

"If most women undergoing hysterectomy for benign conditions each year chose a vaginal or laparoscopic procedure -- rather than TAH or robotic hysterectomy -- performed by skilled and experienced surgeons, pain and recovery times would be reduced while providing dramatic savings to our health care system. Conversely, 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," Breeden said.

More information

The U.S. Office on Women's Health has more about hysterectomy.


SOURCE: American College of Obstetricians and Gynecologists, news release, March 14, 2013

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