Jason Wright, MD
Jason Wright, MD, assistant clinical professor, department of obstetrics and gynecology, Columbia University College of Physicians and Surgeons, New York City. His study was published in Journal of the American Medical Association.
Many women who need hysterectomies are told that robotic-assisted surgery—the newest way to surgically remove the uterus—has numerous advantages over other, “old fashioned” hysterectomy techniques. But a new study suggests that these “benefits” are mostly a matter of marketing hype. Since one in nine women winds up getting a hysterectomy at some point, you may well face the decision about which type of procedure to have. Here’s what you should know…
With the robotic device, the surgeon sits at a console and manipulates the robot’s three or four arms. These arms can move in ways that allow greater range of motion for surgical instruments. The device also provides 3D visualization inside the body.
Any hospital that has sunk nearly $2 million into one of these devices is likely to advertise it on its Web site and in its publications, trying to whip up enthusiasm among patients and help recoup its investment. The advertising is working. Robotic hysterectomies accounted for less than 1% of all hysterectomies in 2007, but for 10% in 2010—and that percentage continues to climb. Marketers claim that robotic hysterectomy is less invasive and thus involves less pain, less bleeding, less scarring, fewer complications and faster recovery than other hysterectomy techniques.
But the claims aren’t necessarily true, a new study from Columbia University College of Physicians and Surgeons reveals.
Robotic hysterectomy is indeed less invasive than the traditional “open” abdominal hysterectomy, which requires an approximately six-to-12-inch incision (and which is still the most commonly performed type of hysterectomy). But robotic hysterectomy is not less invasive than other methods that have far more extensive track records. For instance…
Vaginal hysterectomy is the least invasive method of surgically removing the uterus. It’s done through a small incision at the top of the vagina, with no abdominal incisions or scars at all. Typically, a patient goes home the next day and, though she’ll feel sore for a few days, recovery usually is uneventful and fast. About 21% of hysterectomies are done vaginally.
Laparoscopic hysterectomy, in which the surgeon makes a few tiny incisions in the abdomen and uses a camera and instruments to remove the uterus, is also much less invasive than open abdominal hysterectomy—and about on par with the invasiveness of robotic hysterectomy. About 29% of hysterectomies are done this way.
For the study, researchers analyzed data on nearly 265,000 women from across the US who had hysterectomies for benign problems between 2007 and 2010. (They didn’t look at vaginal hysterectomy because their goal was to compare outcomes of the robotic technique with the laparoscopic technique, as these two are the most similar.)
They did find one advantage to the robot—only about 20% of women who had the robotic surgery stayed in the hospital for more than two days, compared with about 25% of women who had the laparoscopic procedure.
But that was it. There were no benefits at all as far as clinical outcomes. In fact, the complication rate with robotic hysterectomy, at 5.5%, was a smidgeon higher than the 5.3% rate of the laparoscopic procedure. (FYI, other studies suggest that the complications rate with vaginal hysterectomy is about 4%, but the technique is not appropriate for all patients.)
The biggest difference between the two procedures compared in the new study was in the price. On average, robotic hysterectomy cost about 30% more—in dollars, about $2,200 more—than the laparoscopic operation. Hospitals may consider that higher cost an advantage, but patients surely do not!
Remember, this study looked only at women who had hysterectomies for benign conditions. It’s not yet known whether the robot is a better or worse option for complicated cases, such as when a woman has cancer that requires extensive surgery. Further research is needed to answer that question. If your hysterectomy is not expected to be unusual or complicated, however, keep in mind that there is no convincing data showing that robotic hysterectomy is better than—or even as good as—other minimally invasive techniques.
If your doctor is recommending the robotic procedure, have him or her explain exactly why this would be in your best interest, and be sure to discuss the other alternatives, too. If you’re not satisfied that your doctor is separating the marketing hype from the reality, consider getting a second opinion from a physician at a different hospital—to help guard against a hospital-driven, money-focused, pro-robot push.
