Other than cost, the only difference was that patients who underwent laparoscopic hysterectomy were slightly more likely to have a greater than two-day length of stay—one or two days more—than patients who underwent surgery with the robot. Infection rates, intraoperative injuries, reoperations, and transfusions were all essentially the same for either procedure.
The volume of robotic hysterectomy procedures in the United States has grown from 140,000 da Vinci cases in 2011 to 176,000 in 2012, according to a spokeswoman for Intuitive Surgical Inc., which makes the most commonly sold surgical robot, da Vinci. Most, 138,000, were related to non-cancerous conditions addressed in Wright's report.
The volume of robot surgery for hysterectomies now greatly exceeds that for prostate cancer, for which the da Vinci treated 88,000 U.S. patients last year.
Frank Loffer, MD, medical director of the American Association of Gynecologic Laparoscopists and a gynecologic surgeon at the University of Arizona, applauded the paper and suggested it should raise more questions for women choosing between types of hysterectomies, especially when they are led to believe the robot offers a better option.
"Mainly this is marketing on the part of hospitals and physicians, persuading patients to come in fixed on the idea, saying 'I want the latest; I want a robotic procedure, and if you don't do it I'm going to go to the guy next door.' Robotics is the latest and robotics is sexy," Loffer says. A position paper published by the AAGL this month calls for more research comparing the two hysterectomy procedures.