How would you like an inhuman robot poking around in your insides? Sounds like science fiction. However, robotic surgery exists: a live surgeon operates through a computer that remotely controls very small instruments handled by a robot at the operating table.
The robot can mimic the actions of the human surgeon's hand within the small internal space being treated. It is said that the robot's mechanical strength and less fatigue for the surgeon provide advantages in treating obese patients.
James T. Breeden, MD, president of the American Congress of Obstetricians and Gynecologists (the nation’s leading group of physicians providing health care for women), injected a note of caution today into the hot topic of robotic surgery for hysterectomy, the removal of a woman's uterus.
A study published last month in the Journal of the American Medical Association found that the percentage of hysterectomies performed by robot surgeons has jumped from less than half a percent to nearly 10%, just in the past three years.
"Robotic surgery is not the only or the best minimally invasive approach for hysterectomy. Nor is it the most cost-efficient," Dr. Breeden told the press in discussing the three-year trend. "It is important to separate the marketing hype from the reality when considering the best surgical approach for hysterectomies." He added that "studies have shown that adding this expensive technology for routine surgical care does not improve patient outcomes."
When possible, vaginal hysterectomy (through a small opening at the top of the vagina) is the least invasive and least expensive option, the organization has concluded. Its advantages are well documented advantages, and the complication rates are low. For patients who do not qualify for the vaginal route, laparoscopic hysterectomy is the second least invasive and costly. Total abdominal hysterectomy, the old standard, which requires a large incision, costs more and involves more complex aftercare.
The costs of robotic surgery include 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 instruments. A study of over 264,000 hysterectomy patients in 441 hospitals found that robotics added an average of $2,000 per procedure without any demonstrable benefit, Breeden said.
Like both vaginal and laparoscopic surgery, the robotic method generally provides women with "a shorter hospitalization and a faster return to full recovery compared with the traditional total abdominal hysterectomy." However, track records for outstanding patient outcomes and cost efficiencies are proven for the two established methods.
One of the most common major surgeries in the US, hysterectomy typically costs our health care system more than $5 billion a year. Breeden compares it to robotic hysterectomy: if most women undergoing the operation (for benign conditions) had a vaginal or laparoscopic procedure performed by skilled and experienced surgeons—rather than total abdominal or robotic hysterectomy—pain and recovery times would be reduced and savings to the health care system would be "dramatic." Using robotic surgery for all hysterectomies would add $1-2 billion to national health care costs.
Bottom line, for the ob/gyns: robotic hysterectomy is best in unusual and complex clinical conditions (such as difficult cancers) known to benefit by improved outcomes.
Based in Chicago, Sandy Dechert has been covering women's healthcare for Examiner.com since the webzine's official startup. She followed the creation and progress of the Affordable Care Act of 2010. Sandy has also reported on birth control, the 2012-2013 influenza epidemic, top women's health stories of 2012, and the fungal meningitis outbreaks.
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