JAMA study questions benefit of robotic surgery

Researchers: Robotic procedures have higher costs with little added benefit

Surgical robots are increasingly used in hysterectomies, but a new study in JAMA suggests that they offer little added benefit and cost one-third more than other minimally invasive surgery.

  • From the Advisory Board: Our Technology Insights team breaks down a 2012 study on the largest cohort robotic procedures ever to be analyzed.

For the study, researchers at Columbia University examined the records of 264,758 women who had hysterectomies for noncancerous conditions at 441 U.S. hospitals between 2007 and 2010. Surgeons performed the procedure using one of four methods: abdominal cuts; vaginal removal; minimally invasive laparoscopic surgery performed by hand; or minimally invasive surgery using a robot.

The researchers found about 25% of the women who had laparoscopic hysterectomies were hospitalized for more than two days, compared with 20% of those who had robotic surgery.

Meanwhile, the average total cost to the hospital for a robotic surgery was $8,868, compared with $6,679 for the laparoscopic hysterectomy and $6,651 for the abdominal procedure.

The researchers also found that the use of the robot technique grew from 0.5% of hysterectomies performed in 2007 to 9.5% of those performed in 2010. Over that same time period, laparoscopic procedures rose from 24% to 30% of hysterectomies, while abdominal surgeries decreased and vaginal surgeries remained steady.

Moreover, 22% of 2010 hysterectomies at hospitals that invested in robot systems were conducted using a robotic system.

Jason Wright, lead author of the study and an assistant clinical professor of gynecologic oncology at the Columbia, said the main reason for the trend "is that robotic surgery has been marketed extensively to not only hospitals and physicians, but also directly to patients." He added, "There is minimal data in gynecology that it is advantageous."

In an accompanying editorial, hospital policy expert Joel Weissman and Michael Zinner—chair of surgery at Brigham & Women's Hospital—urged hospitals and surgeons to use caution in promoting robotic surgery without additional research showing that the benefits outweigh the costs. Currently, "we've got two options that give you the same outcome" but "one costs a lot more," they wrote (Beck, Wall Street Journal, 2/19; Tanner, AP/Sacramento Bee, 2/19; Painter, USA Today, 2/19).

The Advisory Board's take

Matt Garabrant, Technology Insights

This study harps on a conclusion that we’ve stood by for years.

By the literature, robotic surgery is a valuable tool, but really only in complex cases where the alternative is an open procedure.

Yet when you look at the theory for hospital adoption, it’s clearly more complicated than just the literature. Many patients want it, a large number of surgeons are trained on it, and it’s driven competitive gains for hundreds of hospitals over the years.

But now, with almost 1,400 hospitals in the US offering robotic surgery, the window for competitive differentiation is exceedingly thin. We’re starting to see more folks come to terms with the economics of these procedures, as the costs haven’t changed, but the market share upside is no longer what it used to be. 

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