|Part 2: Can Robotics Improve Surgical Outcomes?|
In Part 2, the authors discuss how robotic laparoscopic hysterectomy compares with traditional laparoscopic hysterectomy. They also explore the clinical implications of one treatment versus the other.
Can robotics improve surgical outcomes?
That’s what one team of researchers sought to determine as they explored its use in the case of laparoscopic hysterectomy. Despite the clinical benefits of laparoscopic hysterectomy, the technical challenges associated with this procedure cause its use to lag well behind conventional laparotomy. Robot-assisted laparoscopy emerged on the scene as a way to assist surgeons in overcoming the technical challenges, but little is known about its comparative clinical effectiveness and economic impact.
We’ve invited members of the research team who explored this question to share what they have learned with us.
Dr. Resad Pasic is professor of obstetrics and gynecology at the University of Louisville, director of operative gynecologic endoscopy, and a co-director of the laparoscopic and minimally invasive gynecologic surgery fellowship. Dr. Pasic has served as the president of the American Association of Gynecologic Laparoscopists (AAGL) and is currently president of the AAGL/American Society for Reproductive Medicine Fellowship Board in minimally invasive gynecologic surgery. He has written extensively in this area and serves on the Editorial Board of OBGYN.net. His website is www.gynlaparoscopy.com.
Dr Candace Gunnarsson owns and operates S2 Statistical Solutions, a consulting firm in Cincinnati, Ohio that performs economic evaluations for medical devices and pharmaceuticals. She has taught statistics courses for more than 10 years in the fields of education, psychology, and business at Xavier University, The Union Institute, and University and University of Cincinnati.
|Mr Matt Moore is a veteran of the health care industry. He is currently the director of reimbursement and health care economics for all of the minimally invasive and core technologies within Ethicon Endo-Surgery. In this position, he is responsible for the development and deployment of reimbursement and health economic outcomes research and evidence for EES products and procedures related to minimally invasive procedures.|
Resad P. Pasic, MD, PhD, John A. Rizzo, PhD, Hai Fang, PhD, Susan Ross, MD,
Matt Moore, MHA, and Candace Gunnarsson, EdD
Objective: To compare clinical and economic outcomes (hospital costs) in women undergoing laparoscopic hysterectomy
performed with and without robotic assistance in inpatient and outpatient settings.
Methods: Using the Premier hospital database, we identified women .18 years of age with a record of minimally invasive
hysterectomy performed in 2007 to 2008. Univariable and multivariable analyses examined the association between robotassisted
hysterectomy and adverse events, hospital costs, surgery time, and length of stay.
Results: Of 36 188 patient records analyzed from 358 hospitals, 95% (n 5 34 527) of laparoscopic hysterectomies were performed
without robotic assistance. Inpatient and outpatient settings did not differ substantively in frequency of adverse events.
For cardiac, neurologic, wound, and vascular complications, frequencies were ,1% for robot and non-robot procedures. In
inpatient and outpatient settings alike, use of robotic assistance was consistently associated with statistically significant,
higher per-patient average hospital costs. Inpatient procedures with and without robotic assistance cost $9640 (95% confidence
interval [CI] 5 $9621, $9659) versus $6973 (95% CI 5 $6959, $6987), respectively. Outpatient procedures with
and without robotic assistance cost $7920 (95% CI 5 $7898, $7942) versus $5949 (95% CI 5 $5932, $5966), respectively.
Inpatient surgery times were significantly longer for robot-assisted procedures, 3.22 hours (95% CI 5 3.21, 3.23) compared
with non-robot procedures at 2.82 hours (95% CI 5 2.81, 2.83). Similarly, outpatient surgery times with robot averaged 2.99
hours (95% CI 5 2.98, 3.00) versus 2.46 hours (2.45, 2.47) for non-robot procedures.
Conclusion: Our findings reveal little clinical differences in perioperative and postoperative events. This, coupled with the
increased per-case hospital cost of the robot, suggests that further investigation is warranted when considering this technology
for routine laparoscopic hysterectomies.
Barbash GI and Glied SA. New Technology and Health Care Costs — The Case of Robot-Assisted Surgery. N Engl J Med. 2010; 363:701-704.