WITHDRAWN: Robotic assisted surgery for gynaecological cancer

Health care cost consequences of using robot technology for hysterectomy: a register-based study of consecutive patients during 2006-2013

The objective of this study is to examine the costs attributable to robotic-assisted laparoscopic hysterectomy from a broad healthcare sector perspective in a register-based longitudinal study. The population in this study were 7670 consecutive women undergoing hysterectomy between January 2006 and August 2013 in public hospitals in Denmark. The interventions in the study were total and radical hysterectomy performed robotic-assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy (TLH), or open abdominal hysterectomy (OAH). Service use in the healthcare sector was evaluated 1 year before to 1 year after the surgery. Tariffs of the activity-based remuneration system and the diagnosis-related grouping case-mix system were used for valuation of primary and secondary care, respectively. Costs attributable to RALH were estimated using a difference-in-difference analytical approach and adjusted using multivariate linear regression. The main outcome measure was costs attributable to OAH, TLH, and RALH. For benign conditions RALH generated cost savings of € 2460 (95% CI 845; 4075) per patient compared to OAH and non-significant cost savings of € 1045 (95% CI -200; 2291) when compared with TLH. In cancer patients RALH generated cost savings of 3445 (95% CI 415; 6474) per patient when compared to OAH and increased costs of € 3345 (95% CI 2348; 4342) when compared to TLH. In cancer patients undergoing radical hysterectomy, RALH generated non-significant extra costs compared to OAH. Cost consequences were primarily due to differences in the use of inpatient service. There is a cost argument for using robot technology in patients with benign disease. In patients with malignant disease, the cost argument is dependent on comparator.

Surgical and clinical safety and effectiveness of robot-assisted laparoscopic hysterectomy compared to conventional laparoscopy and laparotomy for cervical cancer: A systematic review and meta-analysis

AIM

This study aimed to evaluate the surgical safety and clinical effectiveness of RH versus LH and laparotomy for cervical cancer.

METHODS

We searched Ovid-Medline, Ovid-EMBASE, and the Cochrane library through May 2015, and checked references of relevant studies. We selected the comparative studies reported the surgical safety (overall; peri-operative; and post-operative complications; death within 30 days; and specific morbidities), and clinical effectiveness (survival; recurrence; length of stay [LOS]; estimated blood loss [EBL]; operative time [OT]) and patient-reported outcomes.

RESULTS

Fifteen studies comparing RH with OH and 11 comparing RH with LH were identified. No significant differences were found in survival outcomes. The LOS was shorter and transfusion rate was lower with RH compared to OH or LH. EBL was significantly reduced with RH compared to OH. Compared to OH, overall complications, urinary infection, wound infection, and fever were significantly less frequent with RH. The overall, peri-operative, and post-operative complications were similar in other comparisons. Several patient-reported outcomes were improved with RH, though each outcome was reported in only one study.

CONCLUSIONS

RH appears to have a positive effect in reducing overall complications, individual adverse events including wound infection, fever, urinary tract infection, transfusion, LOS, EBL, and time to diet than OH for cervical cancer patients. Compared to LH, the current evidence is not enough to clearly determine its clinical safety and effectiveness. Further rigorous prospective studies with long-term follow-up that overcome the many limitations of the current evidence are needed.