Device maker Ethicon Endo-Surgery recently announced the results of a company-sponsored study that found robot-assisted hysterectomy cost more than traditional laparoscopic hysterectomy but offered no significant advantage in clinical outcomes. According to the analysis, which looked at 36,188 patient records at 358 hospitals, robot-assisted hysterectomy cost $2,667 more on average for inpatient procedures and $1,971 more for outpatient procedures. One of the study’s lead investigators commented that robot-assisted procedures can be valuable for more complex procedures such as laparoscopic prostatectomy or gynecologic oncology, but the study showed that for routine procedures such as laparoscopic hysterectomy, a minimally invasive procedure worked just as well, and at a lower cost, than a robot-assisted one. The results of the study were published in the November/December issue of the Journal of Minimally Invasive Gynecology.
According to the National Institutes of Health, one in three women in the U.S. will undergo a hysterectomy by the age of 60. Minimally invasive laparoscopic hysterectomy was developed as an alternative to the traditional abdominal hysterectomy for women needing to have the uterus removed due to cancer, uterine fibroids, abnormally heavy menstrual bleeding, or other conditions. Instead of a large abdominal incision, surgeons make a number of smaller incisions in the abdomen to remove the uterus. The procedure results in shorter hospital stays, shorter recovery time, less pain, and less scarring.
The results of the Ethicon Endo-Surgery-sponsored study could strike a blow for device makers such as Intuitive Surgical, whose da Vinci Surgical System is used to perform robot-assisted hysterectomies (as well as other surgical procedures) in hospitals across the U.S. Robot-assisted hysterectomy is widely believed to be comparable to its laparoscopic counterpart in terms of surgical outcomes, and proponents cite the improved dexterity and 3-D visualization offered by robotic systems as major advantages.
A recent survey of 277 members of the Society of Gynecologic Oncologists found that nearly 40 percent of respondents considered robotic surgical training to be a required part of their career goals, and 73 percent of respondents had actually performed a robotic hysterectomy. Of the group, 23 percent of respondents thought robot-assisted surgery should be the gold standard for treating endometrial cancer.
For patients who are considering a hysterectomy due to heavy menstrual bleeding, another option may arise from Impres Medical, a Minnetonka, Minn.-based startup that is developing an implantable device to stop heavy menstrual bleeding. The device is designed to deactivate the endometrium, the lining of the uterus, which is shed during menstruation. The technology may also be used to prevent pregnancies. Earlier this year, the company raised $3 million to accelerate commercialization of its technology.
The U.S. Centers for Disease Control and Prevention estimates that 600,000 hysterectomies are performed each year in the U.S. With so many patients undergoing this life-changing surgical procedure, the debate over the merits of each particular treatment--whether abdominal, laparoscopic, robot-assisted, or something else entirely--will continue to be relevant.
What do you think of the Ethicon Endo-Surgery study? Do robot-assisted hysterectomies offer a significant advantage over laparoscopic hysterectomies? Please post your feedback in comments.