TY - JOUR
T1 - Robotic radical hysterectomy
T2 - Comparison of outcomes and cost
AU - Halliday, Darron
AU - Lau, Susie
AU - Vaknin, Zvi
AU - Deland, Claire
AU - Levental, Mark
AU - McNamara, Elizabeth
AU - Gotlieb, Raphael
AU - Kaufer, Rebecca
AU - How, Jeffrey
AU - Cohen, Eva
AU - Gotlieb, Walter H.
N1 - Funding Information:
Acknowledgments Establishment and maintenance of robotic surgery has been made possible in our institution thanks to the philanthropy of a group of donors who requested to remain anonymous. DH was supported by a fellowship grant from the International Gynecologic Cancer Society. This work was supported by grants from the Israel Cancer Research Foundation, the Norych Career Scientist Award, and the Schouella Distinguished Scientist Award.
PY - 2010/12
Y1 - 2010/12
N2 - Operative and peri-operative outcomes, complications, and cost for radical hysterectomy for cervical cancer with negative sentinel nodes have been compared for robotics and laparotomy. Forty patients underwent radical hysterectomy with/out bilateral salpingo-oophorectomy, for early-stage cervical cancer. All cases were performed by one of two surgeons, at a single institution (16 robotic, 24 laparotomy). The data for the robotic group were collected prospectively and compared with data for a historic cohort who underwent laparotomy. The data included demographics and peri-operative variables including operative time, estimated blood loss, lymph node count, hospital stay, and complications. Additionally, real direct hospital cost was compared for both modalities. Patients undergoing robotic radical hysterectomy experienced longer operative time than the laparotomy cohort (351 min vs. 283 min P = 0.0001). Estimated blood loss was significantly lower for the robotic cohort than for the laparotomy cohort (106 ml vs. 546 ml P < 0.0001). The minor complication rate was lower in the robotic cohort than for laparotomy (19% vs. 63% P = 0.003). Average hospital stay for the robotic patients was significantly shorter than for those undergoing laparotomy (1.9 days versus 7.2 days, P < 0.0001). Lymph node retrieval did not differ between the two groups (robotic 15 nodes, laparotomy 13 nodes). The total average peri-operative costs for radical hysterectomy with lymphadenectomy completed via laparotomy was CAN $11,764 ± 6,790, and for robotic assistance 8,183 ± 1,089 (P = 0.002). When amortization of the robot was included, there remained a trend in favor of the robotic approach, but it did not reach statistical significance. Whereas robotics takes longer to perform than traditional laparotomy, it provides the patient with a shorter hospital stay, less need for pain medications, and reduced peri-operative morbidity. In addition real average hospital costs tend to be lower.
AB - Operative and peri-operative outcomes, complications, and cost for radical hysterectomy for cervical cancer with negative sentinel nodes have been compared for robotics and laparotomy. Forty patients underwent radical hysterectomy with/out bilateral salpingo-oophorectomy, for early-stage cervical cancer. All cases were performed by one of two surgeons, at a single institution (16 robotic, 24 laparotomy). The data for the robotic group were collected prospectively and compared with data for a historic cohort who underwent laparotomy. The data included demographics and peri-operative variables including operative time, estimated blood loss, lymph node count, hospital stay, and complications. Additionally, real direct hospital cost was compared for both modalities. Patients undergoing robotic radical hysterectomy experienced longer operative time than the laparotomy cohort (351 min vs. 283 min P = 0.0001). Estimated blood loss was significantly lower for the robotic cohort than for the laparotomy cohort (106 ml vs. 546 ml P < 0.0001). The minor complication rate was lower in the robotic cohort than for laparotomy (19% vs. 63% P = 0.003). Average hospital stay for the robotic patients was significantly shorter than for those undergoing laparotomy (1.9 days versus 7.2 days, P < 0.0001). Lymph node retrieval did not differ between the two groups (robotic 15 nodes, laparotomy 13 nodes). The total average peri-operative costs for radical hysterectomy with lymphadenectomy completed via laparotomy was CAN $11,764 ± 6,790, and for robotic assistance 8,183 ± 1,089 (P = 0.002). When amortization of the robot was included, there remained a trend in favor of the robotic approach, but it did not reach statistical significance. Whereas robotics takes longer to perform than traditional laparotomy, it provides the patient with a shorter hospital stay, less need for pain medications, and reduced peri-operative morbidity. In addition real average hospital costs tend to be lower.
KW - Cervical cancer
KW - Complications, economical considerations
KW - Cost
KW - Laparotomy
KW - Radical hysterectomy
KW - Robotics
UR - http://www.scopus.com/inward/record.url?scp=78649772276&partnerID=8YFLogxK
U2 - 10.1007/s11701-010-0205-z
DO - 10.1007/s11701-010-0205-z
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AN - SCOPUS:78649772276
SN - 1863-2483
VL - 4
SP - 211
EP - 216
JO - Journal of Robotic Surgery
JF - Journal of Robotic Surgery
IS - 4
ER -
