March 21, 2013 — Dr. James T. Breeden, the president of the largest association of gynecologists and obstetricians in the United States, is concerned about robotic hysterectomies performed with the Da Vinci Robotic Surgical System, and has warned that most hysterectomies should not be performed robotically. He is concerned that “aggressive direct-to-consumer marketing of the latest medical technologies may mislead the public into believing that they are the best choice.”
In February 2013, a study published in Journal of the American Medical Association found that robotic hysterectomies were significantly more expensive but offered no benefit over non-robotic vaginal hysterectomies.
The study also found that the percentage of all hysterectomies performed robotically skyrocketed from 0.5% in 2007 to 9.5% in 2010. About 600,000 women have a hysterectomy every year, which means tens of thousands of women are now choosing robotic hysterectomies over traditional vaginal hysterectomies. The reason for the significant increase is unclear, but Dr. Breeden attributed it to marketing:
“Many women today are hearing about the claimed advantages of robotic surgery for hysterectomy, thanks to widespread marketing and advertising. Robotic surgery is not the only or the best minimally invasive approach for hysterectomy. … It is important to separate the marketing hype from the reality when considering the best surgical approach for hysterectomies.”
Dr. Breeden also compared two non-robotic surgical approaches to robotic methods:
- Vaginal hysterectomy: This is the “method of choice whenever technically feasible,” and is performed through incisions in the top of the vagina (no abdominal incisions). The rate of complications is low, and is similar to robotic hysterectomy.
- Total abdominal hysterectomy (TAH): This involves large incisions ins the abdomen. Although robotic surgery has less serious complications than TAH, so does a vaginal hysterectomy or laparoscopic hysterectomy.
Dr. Breeden was also concerned that robotic hysterectomies are substantially more expensive than non-robotic hysterectomies. According to the JAMA study, a robotic hysterectomy is nearly $2,200 more expensive for a patient. Furthermore, hospitals pay $1.7 million to purchase a surgical robot, an additional $125,000 per year in maintenance fees, and $2,000 per procedure for non-reusable instruments. The additional expense is partially levied on the American taxpayer-funded healthcare system. If all hysterectomies were performed robotically, the additional expensive would be $900 million to $1.9 billion per year.
Dr. Breeden concluded by warning: “Studies have shown that adding this expensive technology for routine surgical care does not improve patient outcomes.”
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