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Reuters, Published February 23 2013

Robot-assisted hysterectomies on the rise: Study

The proportion of U.S. 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 U.S. study

But the procedure didn’t reduce the complications linked to a hysterectomy or otherwise improve women’s outlook after surgery, said researchers writing in the Journal of the American Medical Association. It also raised the cost of the procedure by nearly 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.

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

During that time, the number of women treated with 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 the 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 otherwise.

“Robotic surgery has definite advantages in certain clinical situations,” said Weissman – but hysterectomy doesn’t appear to be one of them, though one recent study has suggested that men who have robotic surgery for prostate cancer have fewer complications in the short-term.

“What’s happening is you have an expensive technology that’s being used for less and less necessary things,” Weissman added.

“For most of the things that are done in gynecology, hysterectomy in particular, there are already other minimally-invasive approaches.”

But others disagreed, noting that there is evidence that robotic surgery can be performed on more challenging patients, such as obese women, who might otherwise need open surgery – which comes with more complications.

Wright said that certain types of women – obese women, as well as those with a very large uterus or multiple prior surgeries – might also do better after a robotic procedure.

“Each patient’s scenario is different,” he added.