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 said.
According to the Centers for Disease Control and Prevention, about 600 000
hysterectomies are performed each year in the US.
How the study was done
Researchers led by Dr Jason Wright from Columbia University in New York
analysed 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
The only advantage to robotic surgery was a drop in the proportion of women
staying longer than two days in the hospital - 20%, versus 25% 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.
Surgery-assisting robots, marketed by the company Intuitive Surgical, run for
about $1.5 million.
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
"Robotic surgery has definite advantages in certain clinical situations,"
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 gynaecology, 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
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 said. "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 said future research should look particularly at obese
women, as well as those with a very large uterus or multiple prior
"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.