Study questions benefits of robotic hysterectomy
Mar 03, 2013 (The Columbus Dispatch - McClatchy-Tribune Information Services via COMTEX) --
Robots don't enter operating rooms quietly.
When a hospital buys a robotic surgical tool, its marketing executives enthusiastically share the news, promoting precise, less-invasive operations and a quick recovery. The cost doesn't usually come up.
A recent study is drawing more attention to the balance between the expense and benefit of robots, particularly when it comes to one of the more-common surgical procedures -- hysterectomy.
Robotic operations cost about $2,200 more than older-style minimally invasive surgery and don't come with any fewer complications or blood transfusions, researchers at the Columbia University College of Physicians and Surgeons found in a study published recently in the Journal of the American Medical Association.
The U.S. Food and Drug Administration OK'd robotic hysterectomies in 2005.
The study included 264,758 women treated at 441 hospitals from 2007 to 2010. By 2010, almost 1 in 10 hysterectomies was done robotically. The percentage was much higher when the researchers looked at just those hospitals with a robot.
The study has prompted some to question whether surgeons are using the robots in the cases in which women are most likely to benefit. And it raises questions that include whether it would be better to train more surgeons on minimally invasive surgeries done without the robot, wrote the authors of an editorial that accompanied the research.
Both approaches tend to be better for patients than open surgery; they require smaller incisions, shorter stays and less pain, the researchers said.
Ads are also a concern, they wrote. "When the innovation being advertised is of questionable advantage, direct-to-consumer promotion may only fuel unnecessary utilization."
Surgeons say that most robotic surgeries are for patients who otherwise would have had an open surgery, not traditional laparoscopic surgery. "While we have to be good stewards over our resources, I'm more concerned with the patients' care and recovery," said Dr. Augustus Parker, the director of robotic surgery for Mount Carmel Health System.
Parker said about 98 percent of the procedures he performs are done with the assistance of robotic wrists and fingers that respond to the surgeon's direction. Before robots, minimally invasive surgery was done only with "straight sticks" that can't be bent and maneuvered in the same way.
Many women who would have had an open abdominal surgery are now benefiting from robotic surgery, including those with a lot of abdominal fat and those with larger uteruses.
And learning robotic surgery is considerably easier than learning how to do laparoscopic surgery, said Dr. Stu Jones, Riverside Methodist Hospital's chairman of obstetrics and gynecology.
"Our big opponent in the robotic arena has always been the critics who talked about the price of it," he said.
But as doctors get more experienced, robotic surgeries are getting shorter, and the cost is going down, he said. It's probably now significantly less than what the study found, he said, especially at centers with a high level of expertise.
Ask anyone who works with the robot, and they'll tell you it's a better tool than they had before, said Dr. Michael Blumenfeld, the medical director of the Center for Women's Health at Ohio State University's Wexner Medical Center.
He said it has drastically lowered the number of times he has resorted to an open surgery and has lowered his personal complication rate, but he said there is still a place for laparoscopic, vaginal and open hysterectomies.
Jones said he still does the same amount of laparoscopic surgery he used to; the robot has just replaced open surgery for a large percentage of his patients.
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