A randomized trial comparing vaginal and laparoscopic hysterectomy vs robot-assisted hysterectomy

Abstract

Study objective: To investigate the hospital cost and short-term clinical outcome of traditional minimally invasive hysterectomy vs robot-assisted hysterectomy in women primarily not considered candidates for vaginal surgery.

Design: Randomized controlled trial (Canadian Task Force classification I).

Setting: University Hospital in Sweden.

Patients: One hundred twenty-two women with uterine size ≤ 16 gestational weeks scheduled to undergo minimally invasive hysterectomy because of benign disease.

Interventions: Robot-assisted hysterectomy or traditional vaginal or laparoscopic minimally invasive hysterectomy.

Measurements and main results: All women underwent surgery as randomized. There were no demographic differences between the 2 groups. Vaginal hysterectomy was possible in 41% in the traditional minimally invasive group, at a mean hospital cost of $4579 compared with $7059 for traditional laparoscopic hysterectomy. This was reflected in a mean hospital cost of $993 more per robotic-assisted hysterectomy than for traditional minimally invasive hysterectomy when the robot was a preexisting investment. This hospital cost increased by $1607 when including investments and cost of maintenance. A per-protocol subanalysis comparing laparoscopy and robotics demonstrated similar hospital cost when the robot was a preexisting investment ($7059 vs $7016). Robotic-assisted hysterectomy was associated with less blood loss and fewer postoperative complications.

Conclusion: A similar hospital cost can be attained for laparoscopy and robotics when the robot is a preexisting investment. From the perspective of hospital costs, robotic-assisted hysterectomy is not advantageous for treating benign conditions when a vaginal approach is feasible in a high proportion of patients.

Keywords: Hysterectomy; Laparoscopic hysterectomy; Minimally invasive surgery; Robot-assisted laparoscopy; Vaginal hysterectomy.