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Robot-assisted hysterectomies on the rise

By Genevra Pittman

NEW YORK (Reuters Health) - The proportion of women having their uterus removed using robotic-assisted surgery increased from one in 200 procedures in 2007 to almost one in 10 in 2010, according to a new study.

However, the tool didn't reduce complications linked to hysterectomy or otherwise improve women's outlook after surgery, researchers found. And it raised the cost of the procedure by almost one-third.

"This is clearly in some ways a waste of resources," said Joel Weissman from Brigham and Women's Hospital in Boston, who co-wrote an editorial published with the study.

"It's a waste because there are equally good options and one is just more expensive than the other," he told Reuters Health.

According to the Centers for Disease Control and Prevention, about 600,000 hysterectomies are performed each year in the U.S.

Researchers led by Dr. Jason Wright from Columbia University in New York analyzed records from more than 260,000 women who had the procedure because of endometriosis, bleeding or fibroids between 2007 and 2010.

During that time, the number of women treated both robotic and standard minimally-invasive surgery, rather than open surgery, increased.

During robotic or minimally-invasive non-robotic surgery, a similar proportion of patients - between five and six percent - had complications such as bladder injuries or bleeding. There was also no difference in women's chances of needing a blood transfusion or requiring further care at a nursing home post-surgery, based on procedure type.

The only advantage to robotic surgery was a drop in the proportion of women staying longer than two days in the hospital - 20 percent, versus 25 percent of those who had standard minimally-invasive surgery, also known as laparoscopy.

On average, the bill for a robot-assisted hysterectomy was about $8,900, compared to $6,700 for surgery without the robot, Wright's team wrote Tuesday in the Journal of the American Medical Association.

Surgery-assisting robots, marketed by the company Intuitive Surgical, run for about $1.5 million.

MARKETED HEAVILY

The equipment is used for a range of procedures, and often marketed heavily by hospitals. One recent study suggested men who get robotic surgery for prostate cancer have fewer complications, at least in the short term, than those who have standard prostatectomy - but again, the robot-assisted procedures were more expensive (see Reuters Health story of Sept 6, 2012 here: http://reut.rs/OdVZoZ).

"Robotic surgery has definite advantages in certain clinical situations," Weissman said. But hysterectomy doesn't appear to be one of them.

"What's happening is you have an expensive technology that's being used for less and less necessary things," he said.

"For most of the things that are done in gynecology, hysterectomy is particular, there are already other minimally-invasive approaches," Wright said.

Dr. Myriam Curet, chief medical advisor for Intuitive Surgical and a surgeon at Stanford University in Palo Alto, California, said the new study didn't take into account evidence suggesting robotic surgery can be performed on more challenging patients - such as obese women - who might otherwise need open surgery.

Open surgery is known to come with more complications than either type of less-invasive hysterectomy, Curet added.

"We think that's where the robot can come in," she told Reuters Health. "It allows you to complete more complex patients in a (minimally-invasive) approach than laparoscopy does."

Wright agreed there are certain types of women that may do better after a robotic hysterectomy. He told Reuters Health future research should look particularly at obese women, as well as those with a very large uterus or multiple prior surgeries.

"Each patient's scenario is different, so I think it's important that women have this knowledge, and they should sit down and talk with their doctor about which procedure is best for them," Wright said.

SOURCE: http://bit.ly/JjFzqx Journal of the American Medical Association, online February 19, 2013.

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