Robots in OB-GYN surgery questioned

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.

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