March 21, 2013 — The president of the nation’s organization of obstetricians and gynecologists has warned that robotic surgery is not the best way to perform a hysterectomy.
Dr. James T. Breeden of the American Congress of Obstetricians and Gynecologists (ACOG) had many concerns about the Da Vinci Robotic Surgical System, including “marketing hype,” the learning curve for surgeons, and the fact that robotic surgery does not improve patient outcomes but is significantly more expensive than non-robotic vaginal hysterectomies.
He warned: “Aggressive direct-to-consumer marketing of the latest medical technologies may mislead the public into believing that they are the best choice.”
According to a recent study published in Journal of the American Medical Association (JAMA), the percentage of hysterectomies performed with a surgical robot has skyrocketed from 0.5% to nearly 10% in 2010. The reason for the substantial increase is unclear. With approximately 600,000 hysterectomies performed every year, tens of thousands of women are convinced to choose robotic surgery over traditional methods every year.
Dr. Breeden warned:
“Many women today are hearing about the claimed advantages of robotic surgery for hysterectomy, thanks to widespread marketing and advertising. Robotic surgery is not the only or the best minimally invasive approach for hysterectomy. … It is important to separate the marketing hype from the reality when considering the best surgical approach for hysterectomies.”
Dr. Breeden also compared robotic hysterectomies to non-robotic methods:
- Vaginal hysterectomy: Performed through small incisions in the top of the vagina without abdominal incisions. This is the least invasive, least expensive option for hysterectomies. It has a long history of low complication rates and is the “method of choice whenever technically feasible.” Studies have found that using robotic surgery instead of a vaginal hysterectomy does not improve patient outcomes.
- Total Abdominal Hysterectomy (TAH): Requires a large abdominal incision. Compared to TAH, robotic surgery offers women a faster recovery time, less discomfort, and shorter hospitalization. However, so does a vaginal hysterectomy and laparoscopic hysterectomy.
Dr. Breeden was also concerned that robotic hysterectomies are substantially more expensive to the patient, hospitals, and taxpayers. The JAMA study found that robotics added an additional $2,200 per hysterectomy without any demonstrable benefit. Hospitals purchase each robot for $1.7 million, with $125,000 in annual maintenance costs, and up to $2,000 per surgery for the cost of single-use instruments. If all hysterectomies were performed with a robot, the additional cost to the taxpayer-funded healthcare system would be $960 million to $1.9 billion per year.
In conclusion, Dr. Breeden warned: “Studies have shown that adding this expensive technology for routine surgical care does not improve patient outcomes.”