Comparison of cost and operative outcomes of robotic hysterectomy compared to laparoscopic hysterectomy across different uterine weights

Abstract

Operative cost and outcomes between robotic and laparoscopic hysterectomy across different uterine weights. Retrospective cohort study including patients undergoing robotic and laparoscopic hysterectomy for benign disease at an Academic university hospital. One hundred and ninety six hysterectomies were identified (101 robotic versus 95 laparoscopic). Demographic and surgical characteristics were statistically equivalent. Robotic group had a higher body mass index (±SD) (32.9 ± 6.5 versus 30.4 ± 7.1, p 0.012) and more frequent history of adnexal surgery (12.9 versus 4.2%, p 0.031). Laparoscopic group had a higher number of concurrent salpingectomy (81 versus 66.3%, p 0.02). Estimated blood loss did not differ between procedures. Compared to robotic hysterectomies, laparoscopic procedures added 47 min (CI: 31-63 min; p < 0.001) of operative time, costed $1648 more (CI: 500-2797; p = 0. 005) and had triple the odds of having an overnight admission (OR = 2.94 CI: 1.34-6.44; p = 0.007). After stratification of cases by uterine weight, the mean operative time difference between the two groups in uteri between 750 and 1000 g and in uteri >1000 g was 81.3 min (CI: 51.3-111.3, p < 0.0001) and 70 min (CI: 26-114, p < 0.005), respectively, in favor of the robotic group. Mean direct cost difference in uteri between 750 and 1000 g and uteri >1000 g was 1859$ (CI: 629-3090, p < 0.006) and 4509$ (CI: 377-8641, p < 0.004), respectively, also in favor of the robotic group. In expert hands, robotic hysterectomy for uteri weighing more than 750 g may be associated with shorter operative time and improved cost profile.

Long term COST-minimization analysis of robot-assisted hysterectomy versus conventional laparoscopic hysterectomy

“…It is known that robotic technology is substantially costlier, which is a real concern, considering the increasing pressure to contain costs moving forward. Nevertheless, there is limited evidence of cost analysis studies comparing robotic to laparoscopic hysterectomy for benign indications [16–21] and just 6 studies including abdominal or vaginal approaches [22–27]. Most of those authors conclude that robotic surgical technology appears to be safe and feasible with similar clinical outcomes to open and laparoscopic surgery, and although the clinical evidence of effectiveness is poor, RAH costs are consistently higher than the cost of CLH.…”

Outcomes of robotic, laparoscopic, and open hysterectomy for benign conditions in obese patients

“…Also, although outpatient robotic hysterectomy was demonstrated to be safe and associated with financial savings ( 32 , 33 , 34 ), its safety and feasibility has not yet been evaluated in the obese patient subset. Similarly, costs of robotic gynecologic surgery in benign cases were analyzed with strategies for efficiency ( 35 , 36 ), but there is paucity of the effect of BMI on cost in benign robotic hysterectomy. In addition, because the incidence of occult cancer discovered after minimally invasive gynecologic surgery has been examined ( 37 ), there is a need to examine it in the obese patient population.…”

Cost–benefit analysis of robotic surgery in gynaecological oncology

“…For this reason, they suggested that such patients may benefit from preoperative measures to facilitate earlier discharge [27]. Moreover, Moawad et al showed that robotic hysterectomy for uteri weighing more than 750 gr is associated with shorter mean operative time and improved cost profile compared to laparoscopic approach [28]. Not enough data could be found regarding the possible need of additional postoperative cancer therapies and equivalent cancer specific and overall survival compared to other approaches.…”