March 21, 2013 — The Da Vinci Robotic Surgical System is frequently marketed for hysterectomies (removal of the uterus) with claims that it will provide a woman with a “better overall experience.” The additional benefits of a robotic hysterectomy are clear when compared to abdominal-incision hysterectomies.
However, today, more than 80% of hysterectomies are performed laparoscopically (through minimally-invasive “keyhole” incisions in the abdomen or vagina). When robotic surgery is compared to laparoscopic, non-robotic hysterectomy, the benefits are not so clear.
Unfortunately, there is growing concern that tens of thousands of women are being misled by “aggressive marketing” into choosing a robotic hysterectomy when there is no evidence of patient benefit, but significant increased expense, and a potential risk of life-threatening complications (including FDA reports of equipment malfunctions).
According to an editorial published by Dr. James T. Beeden of the American Congress of Obstetricians and Gynecologists, the largest OB/GYN organization in the United States:
“Robotic surgery is not the only or the best minimally invasive approach for hysterectomy. … Aggressive direct-to-consumer marketing of the latest medical technologies may mislead the public into believing that they are the best choice.”
The Da Vinci Surgical Robot is frequently marketed for robotic hysterectomies with claims of benefits, including:
- Better overall experience
- Reduced trauma to the body
- Less invasive
- 1/2-inch incision instead of a C-section type scar on the abdomen
- More precision
- More surgical features
- Less loss of blood and need for transfusions
- Less post-operative pain
- Lower risk of infection and complications
- Recovery is quicker (as little as one week)
- Shorter hospital stays
- Less scarring
- Less need for pain medications
However, a study published in the Journal of the American Medical Association in February 2013 found that robotic hysterectomies had little benefit for a patient, but they were substantially more expensive. This is alarming, considering that 600,000 hysterectomies are performed every year, and the percentage of robotic hysterectomies has increased from 0.5% in 2007 to 9.5% in 2010.
When researchers compared robotic hysterectomies with laparoscopic hysterectomies, they found similar complication profiles:
- Overall Complications: 5.5% of robotic hysterectomies; 5.3% of laparoscopic hysterectomies.
- Hospital stay longer than 2 days: 19.6% of robotic hysterectomies, 24.9% of laparoscopic hysterectomies.
- Blood transfusion: 1.4% of robotic hysterectomies, 1.8% of laparoscopic hysterectomies.
- Discharge to a nursing facility: 0.2% of robotic hysterectomies, 0.3% of laparoscopic hysterectomies.
- Cost: Robotic surgery was an average of $2,189 more expensive.
The researchers concluded:
“Robotically assisted and laparoscopic hysterectomy had similar morbidity profiles, but the use of robotic technology resulted in substantially more costs.”