Outcomes and cost comparisons after introducing a robotics program for endometrial cancer surgery

Obstet Gynecol. 2012 Apr;119(4):717-24. doi: 10.1097/AOG.0b013e31824c0956.


Objective: To evaluate the effect of introducing a robotic program on cost and patient outcome.

Methods: This was a prospective evaluation of clinical outcome and cost after introducing a robotics program for the treatment of endometrial cancer and a retrospective comparison to the entire historical cohort.

Results: Consecutive patients with endometrial cancer who underwent robotic surgery (n=143) were compared with all consecutive patients who underwent surgery (n=160) before robotics. The rate of minimally invasive surgery increased from 17% performed by laparoscopy to 98% performed by robotics in 2 years. The patient characteristics were comparable in both eras, except for a higher body mass index in the robotics era (median 29.8 compared with 27.6; P<.005). Patients undergoing robotics had longer operating times (233 compared with 206 minutes), but fewer adverse events (13% compared with 42%; P<.001), lower estimated median blood loss (50 compared with 200 mL; P<.001), and shorter median hospital stay (1 compared with 5 days; P<.001). The overall hospital costs were significantly lower for robotics compared with the historical group (Can$7,644 compared with Can$10,368 [Canadian dollars]; P<.001) even when acquisition and maintenance cost were included (Can$8,370 compared with Can$10,368; P=.001). Within 2 years after surgery, the short-term recurrence rate appeared lower in the robotics group compared with the historic cohort (11 recurrences compared with 19 recurrences; P<.001).

Conclusion: Introduction of robotics for endometrial cancer surgery increased the proportion of patients benefitting from minimally invasive surgery, improved short-term outcomes, and resulted in lower hospital costs.

Level of evidence: II.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cost-Benefit Analysis
  • Endometrial Neoplasms / economics
  • Endometrial Neoplasms / surgery*
  • Female
  • Humans
  • Hysterectomy / methods*
  • Hysterectomy / statistics & numerical data
  • Middle Aged
  • Minimally Invasive Surgical Procedures / statistics & numerical data
  • Prospective Studies
  • Retrospective Studies
  • Robotics / economics
  • Robotics / statistics & numerical data*
  • Treatment Outcome