Search Here

Use of robotically-assisted hysterectomy for minor gynecological conditions is on the rise in the U.S., despite the fact that these surgeries are costlier than traditional hysterectomy and have little short-term benefit, according to a new study.

Hysterectomy, according to Medline Plus, is a procedure to remove a woman's uterus. These operations are very common in the country, with every one of three women undergoing this procedure before age 60 years. Fibroids, cancer of the uterus or ovary, vaginal bleeding that persists after treatment and chronic pain in pelvis despite medical intervention are few of the reasons for women undergoing this operation.

Hysterectomy may be performed by either making a cut in the vagina or abdomen, says PubMed Health. The various types of the surgery are abdominal hysterectomy, laparoscopic hysterectomy, laparoscopy-assisted vaginal hysterectomy and robotic hysterectomy.

Robotically-assisted hysterectomy was introduced to make the operation as minimally invasive as possible. "The robotic surgical platform received approval from the U.S. Food and Drug Administration in 2005 for the performance of gynecologic procedures and allows a surgeon to perform the procedure at a remote console," according to background information in the article.

Authors in the present study say that both the traditional and robotic-assisted operations to perform hysterectomy have low complications rates and so it is unclear if the robotically-assisted surgery provides any added benefits.

The study was conducted by Jason D. Wright, M.D., of the Columbia University College of Physicians and Surgeons, New York, and colleagues, who examined the data available from more than 264,000 women who had undergone hysterectomy between 2007 and 2010. In the study group, 46 percent underwent abdominal hysterectomy, 20.7 percent a vaginal hysterectomy, 28.6 percent had a laparoscopic procedure and some 10 percent who had undergone robotically-assisted hysterectomy.

Researchers found that robotic-assisted hysterectomy increased from being 0.5 percent of the procedures (used to remove uterus) to almost 9.5 percent in 2010.

Study results showed that the length of hospital stay was a little shorter for the women undergoing robotically-assisted surgery, while complication risks for both robotic-assisted and laparoscopic hysterectomy were almost the same. The cost of robot-assisted surgery was $2,189 more per case than for laparoscopic hysterectomy.

"Our findings highlight the importance of developing rational strategies to implement new surgical technologies. Robotic surgery first gained prominence for prostatectomy as it essentially offered the only minimally invasive surgical approach for the procedure. Hysterectomy is unlike prostatectomy in that a number of alternatives to open surgery are available; laparoscopic hysterectomy is a well- accepted procedure and vaginal hysterectomy allows removal of the uterus without any abdominal incisions," the researchers wrote.

The study is published in the Journal of the American Medical Association.                               

In an accompanying editorial, Joel S. Weissman, Ph.D., and Michael Zinner, M.D., of Brigham and Women's Hospital, Boston, say that the present study raises many questions like if it is feasible to train people to perform the surgeries than to invest in robots, or if the robotic surgery is better for a subgroup of women.