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WHY DO WE NOT PERFORM ROBOTIC SURGERY?
On March, 2015 the American Collage of Obstetricians and Gynecologists and the Society of Gynecologic Surgeons published a Committee Opinion about robot-assisted surgeries in gynecology. This evidence based document is confirming that robot-assisted surgeries in gynecology are not supported by high-quality patient outcomes, safety, or cost data.
Please read the “Summery of Current Evidence” and if you would like to access the whole document please click here.
Summary of Current Evidence
The rapid adoption of robotic technology for gynecologic surgery is not supported by high-quality patient outcomes, safety, or cost data. A wide array of literature exists, but most studies are retrospective, observational, and noncomparative. Four RCTs compared robot-assisted surgery for benign gynecologic disease with laparoscopy, and none showed any benefit from using the robotic approach. These and other studies show that robot-assisted gynecologic surgery can be performed safely in centers with experienced surgeons and that this minimally invasive approach could be considered for procedures that might otherwise require laparotomy. For gynecologic oncology surgery, there are no data from RCTs. Well-designed RCTs or comparably rigorous nonrandomized prospective trials are needed to determine which patients are likely to benefit from robot-assisted surgery and to establish the potential risks. Adoption of new surgical techniques should be driven by what is best for the patient, as determined by evidence-based medicine rather than external pressures. As with any procedure, adequate informed consent should be obtained from patients before surgery. In the case of robotic procedures, this includes a discussion of the indications for surgery and risks and benefits associated with the robotic technique compared with alternative approaches and other therapeutic options.
OUR APPROACH IS LESS!
Comparing LESS to Robotic Hysterectomy
LESS hysterectomy is different from robotic surgery. While both are minimally invasive procedures, LESS requires a smaller incision than single incision robotic hysterectomy. LESS is also far less expensive than robotic surgery and takes less time to perform. There is a limited amount of published medical evidence comparing LESS hysterectomy to robotic hysterectomy.
However, one study involving 150 women showed a higher complication rate with robotic hysterectomy (5.3%, or approximately 1 of every 20 patients) when compared with LESS (1.3%, or roughly 1 out of every 100 patients). In addition, robotic hysterectomy took, on average, almost three hours (175 minutes) wherein LESS hysterectomy averaged just over two hours (122 minutes). A recent medical study published in the Journal of the American Medical Association found that in over 2,000 procedures performed, robotic hysterectomy cost an average of $2,200 more per procedure without demonstrating any added medical benefit. Furthermore, the American Association of Gynecologic Laparoscopists (the medical society of gynecologic surgeons), as a general rule, does not medically support the use of robotic hysterectomy to treat patients for benign (non-cancerous) gynecologic conditions.