Back in March, a leading obstetrician-gynecologists group questioned the use of surgical robots for routine hysterectomies, citing a study that found robots led to no better results than other procedures but cost much more.
“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,” James Breeden, president of the American Congress of Obstetricians and Gynecologists said in the March statement.
WIth robotic procedures, a surgeon manipulates tiny surgical instruments using hand controls at a computer system situated a few feet away from the patient. Hysterectomies also can be performed through a large abdominal incision (called an open hysterectomy), or through other less invasive approaches, including a small opening at the top of the vagina (ACOG’s preferred approach), or laparoscopic surgery, in which the surgeon manipulates instruments and a tiny lighted camera through small incisions in the abdomen.
ACOG’s strongly worded statement came as use of robots for hysterectomies, one of the most common surgical procedures, jumped from less than 0.5 percent to nearly 10 percent over the past three years, according to a study in the Journal of the American Medical Association. Three hospitals in Maine perform them.
ACOG stated that robotic hysterectomies should be reserved for complex cases.
“Many women today are hearing about the claimed advantages of robotic surgery for hysterectomy, thanks to widespread marketing and advertising,” the statement reads. “Robotic surgery is not the only or the best minimally invasive approach for hysterectomy. Nor is it the most cost-efficient. It is important to separate the marketing hype from the reality when considering the best surgical approach for hysterectomies.”
The JAMA study, which examined more than 260,000 hysterectomy patients, found that “robotics added an average of $2,000 per procedure without any demonstrable benefit,” ACOG said in its statement. The study also found that while patients with robotic hysterectomies were less likely than laparoscopic patients to be hospitalized for more than two days, the two groups showed no difference on other indicators such as complications.
While the statement didn’t name robot maker Intuitive Surgical, the company’s da Vinci robotic surgery system is a chief player in the market.
Despite the warning, all three hospitals in Maine with a da Vinci robot use the device for routine hysterectomies.
Maine Medical Center in Portland performs about 70-80 robot-assisted hysterectomies for benign conditions each year. “We consistently monitor our practices to ensure we are providing safe, high-quality patient care and will continue to offer this service due to the level of safety it provides and the fact that it leads to faster recovery times for patients,” MMC spokesman Matt Paul wrote in an email.
MaineGeneral in Augusta performs about 150 a year.
A spokesman for Eastern Maine Medical Center in Bangor, an early adopter of robotic surgery, hadn’t yet provided a number Friday afternoon, saying it was complicated to define “routine” hysterectomies.
The hospital, which promotes the procedure in an online video, did connect me with Dr. Felix Hernandez, medical director of the surgical division. He took issue with ACOG’s statement, saying it included only hospital bills for surgery and failed to take into account other expenses associated with patients’ recovery post-op, such as time spent away from work and lost productivity after returning.
Those costs are of particular concern to large employers, who face covering disability payments and hiring temporary workers while patients recuperate, in addition to providing the insurance that pays hospitals for the procedures.
“When you look at the cost of the whole episode of care, the cost for robotically assisted hysterectomy is much lower than for open and probably equal to or slightly lower than a laparoscopic hysterectomy,” Hernandez said.
With open hysterectomies, patients remain in the hospital for five to seven days, followed by six to eight weeks of recovery, he said. With robotic procedures, patients are home the next day and back to work within two weeks, Hernandez said. Patients who undergo laparoscopic hysterectomies stay in the hospital a day or two longer and return to work in about two and a half weeks, he said.
I ran Hernandez’s comments by ACOG, which responded with several studies. One, published in the American Journal of Obstetrics and Gynecology, compared regular laparoscopic hysterectomies and robotically assisted procedures and found no difference in postoperative pain and “return to daily activities.” Another published in the same journal cited robotic hysterectomies as among the most profitable procedures in gynecology and urology.