By MELINDA BECK (Wall Street Journal)
The use of robotic surgery for hysterectomies has grown dramatically in recent years, even though it costs one-third more than other minimally invasive surgery and has little added benefit, a major study said Tuesday.
The findings, in the Journal of the American Medical Association, are likely to raise new questions about whether the fast-growing surgical technology brings value to patients along with higher costs. Since 2000, 1,370 U.S. hospitals have purchased at least one of the $1.5 million-to-$2.2 million robots, known as the da Vinci Surgical Systems, made by Intuitive Surgical Inc. ISRG -2.92% of Sunnyvale, Calif.
The only such system for general surgery, da Vinci robots are used for a growing array of procedures, including prostate, gallbladder, cardiovascular and gynecological surgery.
In robotically assisted surgery, the surgeon sits at a console and operates four robotic arms that manipulate miniaturized tools inserted into the patient’s body through small incisions. A tiny lighted camera displays the surgical field in 3-D on video screens.
Proponents say robotic surgery involves less scarring, less pain, less blood loss, fewer complications, shorter hospital stays and a faster recovery than traditional open surgery with a large incision that can take weeks to heal.
Critics say those advantages are due to the fact that it’s a minimally invasive procedure, not that it’s robotic: Conventional laparoscopic surgery, in which surgeons manipulate specialized tools and video camera by hand through small incisions, is also minimally invasive, at less cost.
For the new study, researchers at Columbia University examined the records of 264,758 women who had hysterectomies—removal of the uterus—for noncancerous conditions at 441 U.S. hospitals from 2007 to 2010. During that time, robotic surgery rose from 0.5% to nearly 10% of all the hysterectomies studied and 22% of those at hospitals where robotic surgery was offered. Laparoscopic procedures rose from 24% to 30%. Open surgeries dropped but were still the most common form of hysterectomy as of 2010. A fourth option, where the uterus is removed vaginally, remained about 20%.
About 25% of the women who had laparoscopic hysterectomies stayed in the hospital longer than two days, compared with 20% of those who had robotic procedures. But the overall complication rate was the same—5%—for both groups.
The average total cost to the hospital for the robotic hysterectomy was $8,868, compared with $6,679 for a laparoscopic procedure and $6,651 for the open surgery.
“There are so many options for hysterectomies now that patients should discuss the pros and cons of all of them with their doctors,” said the study’s lead author, Jason Wright, an associate professor of women’s health at Columbia University. The research was supported by a grant from the National Cancer Institute.
Myriam Curet, chief medical adviser for Intuitive Surgical, says robotic surgery should be compared with open, not laparoscopic, surgery: “We did not develop the robot to compete with laparoscopic surgery. We developed the robot to bring the benefits of minimally invasive surgery to more women.”