ACOG: Robotic surgery is not the best
President speaks out on hysterectomy options
While many women are hearing about the claimed advantages of robotic surgery for hysterectomy, thanks to widespread marketing and advertising, robotic surgery is not the best minimally invasive approach for hysterectomy, according to James T. Breeden, MD, president of the American College of Obstetricians and Gynecologists (ACOG).
“Nor is it the most cost-efficient,” Breeden said in a released statement. “It is important to separate the marketing hype from the reality when considering the best surgical approach for hysterectomies.”
Studies show there is a learning curve with new surgical technologies, during which there are increased complications, he said. “Expertise with robotic hysterectomy is limited and varies widely among both hospitals and surgeons,” Breeden said.
There might be some advantages to using robotics in complex hysterectomies, especially for cancer operations that require extensive surgery and removal of lymph nodes, he said. However, “studies have shown that adding this expensive technology for routine surgical care does not improve patient outcomes,” Breeden said. “Consequently, there is no good data proving that robotic hysterectomy is even as good as — let alone better — than existing, and far less costly, minimally invasive alternatives.”
For example, he points to vaginal hysterectomy as the least invasive and least expensive option. “Based on its well-documented advantages and low complication rates, this is the procedure of choice whenever technically feasible,” Breeden said. “When this approach is not possible, laparoscopic hysterectomy is the second least invasive and costly option for patients.”
Robotic hysterectomy generally provides women with a shorter hospitalization, less discomfort, and a faster return to full recovery compared with the traditional total abdominal hysterectomy (TAH), he said. “However, both vaginal and laparoscopic approaches also require fewer days of hospitalization and a far shorter recovery than TAH,” Breeden said. These two methods also have proven track records for outstanding patient outcomes and cost efficiencies, he said.
“At a time when there is a demand for more fiscal responsibility and transparency in healthcare, the use of expensive medical technology should be questioned when less-costly alternatives provide equal or better patient outcomes,” Breeden said.
At a price of 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, robotic surgery is the most expensive approach, he said. A recent Journal of the American Medical Association study found that the percentage of hysterectomies performed robotically has jumped from less than 0.5% to nearly 10% over the past three years. A study of over 264,000 hysterectomy patients in 441 hospitals also found that robotics added an average of $2,000 per procedure without any demonstrable benefit.
“If most women undergoing hysterectomy for benign conditions each year chose a vaginal or laparoscopic procedure — rather than TAH or robotic hysterectomy — performed by skilled and experienced surgeons, pain and recovery times would be reduced while providing dramatic savings to our healthcare system,” Breeden said.
Aggressive direct-to-consumer marketing of the latest medical technologies might mislead the public into believing that they are the best choice, Breeden said. “Our patients deserve and need factual information about all of their treatment options, including costs, so that they can make truly informed healthcare decisions,” he said. “Patients should be advised that robotic hysterectomy is best used for unusual and complex clinical conditions in which improved outcomes over standard minimally invasive approaches have been demonstrated.”
While many women are hearing about the claimed advantages of robotic surgery for hysterectomy, thanks to widespread marketing and advertising, robotic surgery is not the best minimally invasive approach for hysterectomy, according to James T. Breeden, MD, president of the American College of Obstetricians and Gynecologists (ACOG).You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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