Robots in OB-GYN surgery ques­tioned

Modern Healthcare - - NEWS - By Jaimy Lee

A study is ques­tion­ing the use of robots in gy­ne­co­log­i­cal surgery after they pro­duced in­fe­rior out­comes and had higher costs com­pared with la­paroscopy, the ma­jor al­ter­na­tive.

Robot­i­cally as­sisted ad­nexal surgery— any surgery in­volv­ing ovaries, fal­lop­ian tubes or ovar­ian cysts—had a small but sta­tis­ti­cally sig­nif­i­cantly in­crease in com­pli­ca­tion rates com­pared with la­paroscopy. The study ap­peared in the Oc­to­ber is­sue of the jour­nal Ob­stet­rics & Gynecology.

In each of the pro­ce­dures the au­thors stud­ied, the me­dian to­tal cost for a robot­i­cally as­sisted pro­ce­dure was higher when com­pared to la­paro­scopic surgery for the same treat­ment. For ex­am­ple, the to­tal me­dian cost for a robot­i­cally as­sisted oophorec­tomy—a sur­gi­cal pro­ce­dure where a pa­tient has one or both ovaries re­moved—was $7,426, while a la­paro­scopic oophorec­tomy was roughly $4,922.

“Be­fore wide­spread ac­cep­tance, ad­di­tional rig­or­ous data sup­port­ing the safety and com­par­a­tive ef­fec­tive­ness of robot­i­cally as­sisted ad­nexal surgery should be col­lected,” the au­thors con­cluded.

An in­creas­ing num­ber of ex­perts have ques­tioned the clin­i­cal ev­i­dence and higher costs as­so­ci­ated with sur­gi­cal robots, which cost health­care providers be­tween $1.5 mil­lion and $2 mil­lion. In­tu­itive Sur­gi­cal, the only company with a ro­botic sys­tem ap­proved by the Food and Drug Ad­min­is­tra­tion, has re­ported that about 1,500 hos­pi­tals in the U.S. have in­stalled the da Vinci Sur­gi­cal Sys­tem in the nearly 15 years it’s been on the mar­ket.

But us­ing ro­botic surgery in­stead of la­paro­scopic surgery for pro­ce­dures such as hys­terec­tomies is on the de­cline. The Amer­i­can Col­lege of Ob­ste­tri­cians and Gy­ne­col­o­gists, in par­tic­u­lar, has been crit­i­cal of the mar­ket­ing of the da Vinci sys­tem. “There (are) no good data prov­ing that ro­botic hys­terec­tomy is even as good as—let alone bet­ter—than ex­ist­ing, and far less costly, min­i­mally in­va­sive al­ter­na­tives,” ACOG Pres­i­dent Dr. James Breeden said in 2013.

The da Vinci Sur­gi­cal Sys­tem

costs up to $2 mil­lion.

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