Robotic hysterectomies not worth the cost

Joel Weissman and Michael Zinner summarize recent work on robotic surgery.

Wright et al compared the use of robotically assisted hysterectomy for benign gynecologic disease with other approaches. Whereas past research relied on smaller samples in single institutions with limited generalizability, this study used a large national database involving 264,758 women who underwent hysterectomy at 441 hospitals and included detailed clinical variables, comorbidities, and outcomes of perioperative mortality and morbidity. The findings were stark. From 2007 to 2010, overall use of robotically assisted hysterectomy increased from 0.5% to 9.5%, and at hospitals that performed robotic procedures, robotically assisted hysterectomy accounted for 22.4% of all hysterectomies within 3 years. In addition, compared with laparoscopic surgery, robotic surgery was much more expensive—$2000 more per case or nearly a third higher than the median total cost for laparoscopic hysterectomy—without a significant advantage in clinical outcomes.

On these results alone, the call is a simple one. At current prices and on the basis of health outcomes, robotic hysterectomies are not worth the cost.

Limitation: Write et al.’s study is not an RCT. Prior TIE coverage of robotic surgery by Kevin and me.


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