The debate over the efficacy and costs of robotic surgery continues with a new study published in the Journal of the American Medical Association.
According to the Feb. 19, Wall Street Journal, the findings of this large scale study “are likely to raise new questions about whether the fast-growing surgical technology brings value to patients along with higher costs.”
The study examined the records of 264,758 women who had hysterectomies from 2007 to2010. During that three year period, robotic surgery for hysterectomies rose almost 10%, laparoscopic hysterectomies rose 6%, and although the number of open surgeries declined, they remained the most common type of hysterectomy.
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 for the robotic hysterectomy was about 25% higher than both laparoscopic procedure and open surgery which were dollars of costing the same.
Since 2000, a total of 1370 hospitals have purchased one or more of the da Vinci Surgical Systems, made by Intuitive Surgical Inc. of Sunnyvale, Ca.
The da Vinci robots are the only robots designed for general surgery, including prostate, gallbladder, cardiovascular and gynecological surgery.
Robotic surgery is actually a tool that a surgeon or team of surgeons uses to assist in the procedure.
The surgeon still assumes the operating and decision making role while he or she “sits at a console and operates four robotic arms that manipulate miniaturized tools inserted into the patient's body through small incisions.” Not unlike laparoscopic surgery the surgical field is displayed in 3-D on video screens via a lighted camera.
According to the WSJ, “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,” while critics say “those advantages are due to the fact that it's a minimally invasive procedure, not that it's robotic.”
Gynecological surgeon Marie Paraiso at the Cleveland Clinic in Ohio said that doctors have yet to define which patients robotic surgery “helps most and it's never been shown to be cost-effective."
Dr. Paraiso who performs both laparoscopic and robotic hysterectomies, in a separate study randomly assigned 53 hysterectomy patients to either laparoscopic or robotic surgery. Dr. Paraiso and her colleagues found “no significant differences in blood loss, pain or recovery between the groups, but the robotic surgery did take an average of 77 minutes longer than the laparoscopic version, which brings added costs.”
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