COMMENTARY

Use of the Robot for Benign Gynecologic Surgery: Help or Hype?

Andrew Kaunitz, MD; Brent E. Seibel, MD

Disclosures

January 05, 2012

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Hello. I'm Andrew Kaunitz, Professor and Associate Chair of the Department of Obstetrics and Gynecology at the University of Florida College of Medicine in Jacksonville, Florida. Today I would like to discuss Use of the Robot for Benign Gynecologic Surgery: Help or Hype?

Use of the da Vinci® surgical system to perform benign gynecologic surgeries is increasing rapidly in the United States. Hospitals pay between $1 and $2.3 million to purchase such systems, annual maintenance costs range between $100,000 and $170,000, and instrumentation costs for each procedure range between $1300 and $2200.[1]

Sacrocolpopexy is the gold standard for surgical repair of vaginal prolapse, and can be performed laparoscopically with lower morbidity and shorter hospital stays compared with open abdominal surgery. The laparoscopic approach, however, requires suturing and knot-tying skills that can be difficult to master. Investigators at the Cleveland Clinic recently published a randomized trial that compared conventional laparoscopic and robot-assisted laparoscopic sacrocolpopexy for posthysterectomy vaginal prolapse in 78 women.[2] Patients and research staff were blinded to treatment assignments.

Overall mean operating times were more than 1 hour longer in the robotic surgery group. Although the incidence of perioperative complications was similar in the 2 groups, women randomized to robotic surgery reported significantly greater pain 3 to 5 weeks after surgery. At 6 and 12 months, excellent anatomic results were noted in the great majority of women in both groups, and quality-of-life measures were likewise similar. Mean costs of robotic-assisted procedures were almost $2000 higher, largely reflecting instrumentation costs.

The good news is that this landmark trial found that sacrocolpopexy with either minimally invasive approach yields excellent results at 1 year. However, the high costs and greater postoperative pain associated with use of the robot is sobering, and suggests the caution flag should be raised as use of this approach for benign gynecologic surgeries continues to increase.

I would like to thank Dr. Brent Seibel, gynecologic surgeon and faculty member in our department, for his help in preparing this commentary.

Thank you. I am Andrew Kaunitz.

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