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Is robotic laparoscopic hysterectomy better than conventional laparoscopic hysterectomy?

Robin Wulffson MD's picture
robotic surgery, hysterectomy, traditional surgery, comparison

With the growing popularity of robotic assisted laparoscopic procedures, researchers seek to find whether this procedure is an improvement over the traditional approach. A comparison was made by researchers from Kantonsspital Aarau (Aarau, Switzerland) and University Hospital Basel (Basel, Switzerland).

They published their findings in the September 2012 edition of the journal Obstetrics & Gynecology.

Traditionally, hysterectomies have been performed by open surgery, either via the abdominal or vaginal approach. Several decades ago, some gynecologic surgeons adopted the laparoscopic approach; however, most procedures continued to be done by the traditional approach.

A major breakthrough occurred in laparoscopy just before the turn of the century with the introduction of robotic surgery. The surgeon no longer had to hunch over the operating table; instead, he or she could sit at a console and view a magnified 3D image of internal structures by manipulating instruments that control robotic arms. Most gynecologic procedures can now be performed with the surgical robot, such as hysterectomies, myomectomies (removal of fibroid tumors on the uterus), removal of ovarian tumors, and even cancer surgeries. Current estimates are that 30-40% of all hysterectomies are now performed laparoscopically; furthermore, an ever-increasing number of surgeons are using the robot.

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The researchers set out to compare surgical outcome and quality of life of robot-assisted laparoscopic hysterectomy with conventional laparoscopic hysterectomy. Patients with benign (non-cancerous) indications for hysterectomy were randomized to receive either a robotic (robotic group) or conventional laparoscopic hysterectomy (conventional group). The primary outcome measure was total operating time; the secondary outcome measures were perioperative outcome, blood loss, and the change in quality of life.

Of 100 randomized patients, 95 completed the study. The researchers found not significant differences in patient age, body mass index, and uterus weight between the two groups. They found that the total operating time for the robotic group was significantly higher (robotic group: 106 minutes average; conventional group: 75 minutes average: average difference: 29 minutes) in the robotic group. Blood loss, complications, analgesics (pain killers) use, and return to activity for both groups were comparable. The change in preoperative to postoperative quality-of-life index (quality of life measured on a scale from 0 to 100) was significantly higher in the robotic group (robotic group: 13; conventional group: 5).

The authors concluded that robot-assisted laparoscopic hysterectomy and conventional laparoscopy compare well in most surgical aspects; however, the robotic procedure is associated with longer operating times. Subjective postoperative parameters such as analgesic use and return to activity showed no significant difference between both groups. Postoperative quality-of-life index was better in the robotic group; however, long-term, there was no difference.

I recently interviewed Oliver Dorigo, MD, PhD, an assistant professor of gynecology at the UCLA David Geffen School of Medicine. Dr. Dorigo specializes in gynecologic cancer surgery and is an expert in laparoscopic robotic surgery. A problem with traditional laparoscopy was that of suturing tissues; however, Dr. Dorigo reports that this function is vastly improved by the robotic approach. One of the most difficult gynecologic procedures is a pelvic exenteration for aggressive cancers. It entails removal of the uterus, cervix, ovaries, fallopian tubes, vagina, bladder, urethra (tube emptying the bladder), and rectum. Dr. Dorigo and this team at UCLA have accomplished pelvic exenterations with robotic surgery. Recent studies have suggested that robotic surgery may be safer than conventional surgery; however it is more expensive. The most popular robotic system, the da VinciĀ® Surgical System cost $1.7 million or more and incurs significant maintenance costs. The higher cost is offset not only by its safety record but also by shorter hospital stay, less blood loss, less postoperative pain, and a quicker recovery.

Reference: Obstetrics & Gynecology

This page is updated on May 11, 2013.