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Comparative Study
. 2012 Mar 10;30(8):783-91.
doi: 10.1200/JCO.2011.36.7508. Epub 2012 Jan 30.

Comparative effectiveness of robotic versus laparoscopic hysterectomy for endometrial cancer

Jason D Wright  1 , William M Burke, Elizabeth T Wilde, Sharyn N Lewin, Abigail S Charles, Jin Hee Kim, Noah Goldman, Alfred I Neugut, Thomas J Herzog, Dawn L Hershman
Affiliations
Comparative Study

Comparative effectiveness of robotic versus laparoscopic hysterectomy for endometrial cancer

Jason D Wright et al. J Clin Oncol. .

Abstract

Purpose: Use of robotics in oncologic surgery is increasing; however, reports of safety and efficacy are from highly experienced surgeons and centers. We performed a population-based analysis to compare laparoscopic hysterectomy and robotic hysterectomy for endometrial cancer.

Patients and methods: The Perspective database was used to identify women who underwent a minimally invasive hysterectomy for endometrial cancer from 2008 to 2010. Morbidity, mortality, and cost were evaluated using multivariable logistic and linear regression models.

Results: We identified 2,464 women, including 1,027 (41.7%) who underwent laparoscopic hysterectomy and 1,437 (58.3%) who underwent robotic hysterectomy. Women treated at larger hospitals, nonteaching hospitals, and centers outside of the northeast were more likely to undergo a robotic hysterectomy procedure, whereas black women, those without insurance, and women in rural areas were less likely to undergo a robotic hysterectomy procedure (P < .05 for all). The overall complication rate was 9.8% for laparoscopic hysterectomy versus 8.1% for robotic hysterectomy (P = .13). The adjusted odds ratio (OR) for any morbidity for robotic hysterectomy was 0.76 (95% CI, 0.56 to 1.03). After adjusting for patient, surgeon, and hospital characteristics, there were no significant differences in the rates of intraoperative complications (OR, 0.68; 95% CI, 0.42 to 1.08), surgical site complications (OR, 1.49; 95% CI, 0.81 to 2.73), medical complications (OR, 0.64; 95% CI, 0.40 to 1.01), or prolonged hospitalization (OR, 0.85; 95% CI, 0.64 to 1.14) between the procedures. The mean cost for robotic hysterectomy was $10,618 versus $8,996 for laparoscopic hysterectomy (P < .001). In a multivariable model, robotic hysterectomy was significantly more costly ($1,291; 95% CI, $985 to $1,597).

Conclusion: Despite claims of decreased complications with robotic hysterectomy, we found similar morbidity but increased cost compared with laparoscopic hysterectomy. Comparative long-term efficacy data are needed to justify its widespread use.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Distribution of minimally invasive laparoscopic hysterectomies and robotic hysterectomies performed from October 2008 to March 2010.
See this image and copyright information in PMC

Comment in

References

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