"The future of surgery is not about blood and guts; the future of surgery is about bits and bytes.”
/Dr. Richard Satava/

Tuesday, February 26, 2013

Da Vinci hysterectomy under investigation

Since 2011, hysterectomy became the most common procedure of the da Vinci. There are approximately 600,000 cases a year in the US, and da Vinci hysterectomy (approved in 2005) has increased its penetration from 0.5% in 2007 to 9.5% in 2010. A recent study published in the Journal of the American Medical Association found no difference in the surgical outcome of dVH versus hand-held laparoscopy. (Even the editorial was analyzing these results: "rapid dissemination of robotic surgery in the United States may be linked to a number of converging factors, including better ergonomics for the surgeon, marketing campaigns, and the national fascination with technology and innovation...")
"Cohort study of 264 758 women who underwent hysterectomy for benign gynecologic disorders at 441 hospitals across the US from 2007 to 2010 found:
  • the overall complication rates were similar for robotic-assisted and laparoscopic hysterectomy (5.5% vs 5.3%; relative risk [RR])
  • patients who underwent a robotic-assisted hysterectomy were less likely to have a length of stay longer than 2 days (19.6% vs 24.9%; RR)
  • transfusion requirements (1.4% vs 1.8%; RR) 
  • rate of discharge to a nursing facility (0.2% vs 0.3%; RR) 
Total costs associated with robotically assisted hysterectomy were $2189 more per case than for laparoscopic hysterectomy. Median cost to the hospital of robotic procedure is $8,868, compared with $6,679 for laparoscopic hysterectomy."

4 comments:

Jim Smithson said...

Yeah, the only problem is that most hysterectomies WEREN'T done in a minimally invasive way prior to the robot. Sure - a skilled lap surgeon could do it but they weren't. OBGYNs are great at delivering babies - their surgical, especially laparoscopic skills leave something to be desired. The robot's competition isn't lap surgery - it is open. If you compare open hysterectomies to robotic, there are significant differences.

This is stated in the JAMA article and a lot of very educated people seem to have been missing the point here.

T. said...

A valid comment. Da Vinci has the most benefit in these cases for the surgeons. However, there is not much to do if some hate it... Also some other publications on this: http://www.nietoeditores.com.mx/download/Cirugia%20y%20Cirujanos/2012/Cir-Cir%206/CIR%20CIr%206%20ingles/Cir%20Cir%206%20ingles%20Comparison.pdf

Geraldine Galvan said...

If that's the case then we don't really have a reason whatsoever to resort to this type of surgery. It just makes us spend more because the Da Vinci surgery is far more expensive than the traditional one.
Not only that, I've also heard that there are many complaints associated to this type of surgical procedure in which some of them even resort to filing a Da Vinci surgical system lawsuit.

This is not be the case if the surgical procedure is truly safe and effective.

T. said...

It's not that simple. Da Vinci surgery is better, in terms or ergonomics. Mostly ergonomics to the surgeon that leads to an overall benefit to the patient. Yet, it is more expensive, for sure! Complications rates with the robot has shown to be average, or lower. Nevertheless, there is NO surgery without risk! Da Vinci is only an advanced tool (ALWAYS under the control of the surgeon), not a magical device.