Skip to main content
SpringerLink
Log in

Direct cost of hysterectomy: comparison of robotic versus other routes

  • Original Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

The aim of this study was to investigate the direct cost of robotic hysterectomy in comparison with abdominal, vaginal, and laparoscopic routes past the initial learning curve. We examined a consecutive case series of 348 patients undergoing abdominal (AH), vaginal (VH), laparoscopic (LH), or robotic hysterectomy (RH) for benign conditions between January 2015 and March 2017. The primary outcome was the direct cost of hysterectomy, while the secondary outcome was length of stay. Multiple linear regression was used to examine the cost and length of stay across the four hysterectomy groups after controlling for potential confounding variables. 19 (5.5%) patients underwent AH, 53 (15.2%) LH, and 59 (16.9%) VH, while 217 (62.4%) RH. VH group was the oldest at age 52.1 years (p < 0.01), whereas AH group had the highest BMI at 35.9 kg/m2 (p = 0.03). While colporrhaphy was most frequently performed in VH (81%), mid-urethral sling was most common in RH (30%) (p < 0.01). The average direct cost was $3865 for RH, $4063 for AH, $2791 for VH, and $3818 for LH. Upon multivariate analysis, RH and VH were $650.47 (p < 0.01) and $883.07 (p < 0.01) cheaper, respectively, compared to AH. The average length of stay was the shortest for RH at 10.7 h, followed by LH at 15.5 h, vaginal at 20 h, and abdominal at 51.5 h (p < 0.01). VH has the lowest direct cost, while AH has the highest. Both VH and RH have a significantly lower cost than that of AH. RH has the shortest hospital stay, whereas AH has the longest.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Center for Disease Control and Prevention (2014) Discharges with at least one procedure in nonfederal short-stay hospitals, by sex, age, and selected procedures: United States, selected years 1990 through 2009–2010. https://www.cdc.gov/nchs/data/hus/2014/090.pdf

  2. Wright JD, Ananth CV, Lewin SN, Burke WM, Lu YS, Neugut AI et al (2013) Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease. JAMA 309(7):689–698

    Article  CAS  Google Scholar 

  3. Winter ML, Leu SY, Lagrew DC Jr, Bustillo G (2015) Cost comparison of robotic-assisted laparoscopic hysterectomy versus standard laparoscopic hysterectomy. J Robot Surg 9(4):269–275

    Article  Google Scholar 

  4. Landeen LB, Bell MC, Hubert HB, Bennis LY, Knutsen-Larson SS, Seshadri-Kreaden U (2011) Clinical and cost comparisons for hysterectomy via abdominal, standard laparoscopic, vaginal and robot-assisted approaches. S D Med 64(6):197–199

    PubMed  Google Scholar 

  5. Sarlos D, Kots L, Stevanovic N, Schaer G (2010) Robotic hysterectomy versus conventional laparoscopic hysterectomy: outcome and cost analyses of a matched case–control study. Eur J Obstet Gynecol Reprod Biol 150(1):92–96

    Article  Google Scholar 

  6. Swenson CW, Kamdar NS, Harris JA, Uppal S, Campbell DA Jr, Morgan DM (2016) Comparison of robotic and other minimally invasive routes of hysterectomy for benign indications. Am J Obstet Gynecol 215(5):650

    Article  Google Scholar 

  7. Iavazzo C, Mamais I, Gkegkes ID (2016) Robotic assisted vs laparoscopic and/or open myomectomy: systematic review and meta-analysis of the clinical evidence. Arch Gynecol Obstet 294(1):5–17

    Article  Google Scholar 

  8. Matthews CA, Reid N, Ramakrishnan V, Hull K, Cohen S (2010) Evaluation of the introduction of robotic technology on route of hysterectomy and complications in the first year of use. Am J Obstet Gynecol 203(5):499–500

    Article  Google Scholar 

  9. Beste TM, Nelson KH, Daucher JA (2005) Total laparoscopic hysterectomy utilizing a robotic surgical system. JSLS 9(1):13–15

    PubMed  PubMed Central  Google Scholar 

  10. Diaz-Arrastia C, Jurnalov C, Gomez G, Townsend C Jr (2002) Laparoscopic hysterectomy using a computer-enhanced surgical robot. Surg Endosc 16(9):1271–1273

    Article  CAS  Google Scholar 

  11. Fiorentino RP, Zepeda MA, Goldstein BH, John CR, Rettenmaier MA (2006) Pilot study assessing robotic laparoscopic hysterectomy and patient outcomes. J Minim Invasive Gynecol 13(1):60–63

    Article  Google Scholar 

  12. Woelk JL, Borah BJ, Trabuco EC, Heien HC, Gebhart JB (2014) Cost differences among robotic, vaginal, and abdominal hysterectomy. Obstet Gynecol 123(2 Pt 1):255–262

    Article  Google Scholar 

  13. Wright KN, Jonsdottir GM, Jorgensen S, Shah N, Einarsson JI (2012) Costs and outcomes of abdominal, vaginal, laparoscopic and robotic hysterectomies. JSLS 16(4):519–524

    Article  Google Scholar 

  14. Geller EJ, Matthews CA (2013) Impact of robotic operative efficiency on profitability. Am J Obstet Gynecol 209(1):20–25

    Article  Google Scholar 

  15. Avondstondt AM, Wallenstein M, D’Adamo CR, Ehsanipoor RM (2018) Change in cost after 5 years of experience with robotic-assisted hysterectomy for the treatment of endometrial cancer. J Robot Surg 12(1):93–96

    Article  Google Scholar 

  16. (2014) Firm policies and the right procedures tip the cost-benefit balance toward flip rooms. OR Manag 30(4):19–21

  17. Bosco UJ, Peters JA, Torrance A (2016) The elephant in the or: improving performance for long surgical cases. Physician Leadersh J 3(3):8–12

    PubMed  Google Scholar 

  18. Childers CP, Maggard-Gibbons M (2018) Understanding costs of care in the operating room. JAMA Surg 153(4):e176233

    Article  Google Scholar 

  19. Payne TN, Dauterive FR (2010) Robotically assisted hysterectomy: 100 cases after the learning curve. J Robot Surg 4(1):11–17

    Article  Google Scholar 

  20. Rosero EB, Kho KA, Joshi GP, Giesecke M, Schaffer JI (2013) Comparison of robotic and laparoscopic hysterectomy for benign gynecologic disease. Obstet Gynecol 122(4):778–786

    Article  Google Scholar 

  21. Jacoby VL, Autry A, Jacobson G, Domush R, Nakagawa S, Jacoby A (2009) Nationwide use of laparoscopic hysterectomy compared with abdominal and vaginal approaches. Obstet Gynecol 114(5):1041–1048

    Article  Google Scholar 

  22. Dubeshter B, Angel C, Toy E, Thomas S, Glantz JC (2013) Current role of robotic hysterectomy. J Gynecol Surg 29(4):174–178

    Article  Google Scholar 

  23. Jones HH, Lynch K, Goldman NA, Rutledge J, Burke WM (2015) Robotic-assisted hysterectomy complication rates are similar for all uterine weights [109]. Obstet Gynecol 125:40S

    Article  Google Scholar 

  24. Moawad GN, Abi Khalil ED, Tyan P, Shu MK, Samuel D, Amdur R et al (2017) Comparison of cost and operative outcomes of robotic hysterectomy compared to laparoscopic hysterectomy across different uterine weights. J Robot Surg 11(4):433–439

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the administration of UnityPoint Health Allen Memorial Hospital for their support in providing the resources to accomplish the study.

Author information

Authors and Affiliations

  1. Des Moines University, Des Moines, IA, USA

    Bilal Kaaki

  2. Department of Obstetrics and Gynecology, UnityPoint Health, 1825 Logan Ave., Waterloo, IA, 50703, USA

    Bilal Kaaki

  3. University of Iowa, Iowa City, IA, USA

    Emma Lewis

  4. UnityPoint Health, Waterloo, IA, USA

    Sukruta Takallapally

  5. UnityPoint Health, Des Moines, IA, USA

    Benjamin Cleveland

Authors
  1. Bilal Kaaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emma Lewis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sukruta Takallapally
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Benjamin Cleveland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bilal Kaaki.

Ethics declarations

Conflict of interest

Authors BK, EL, ST, and BC declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The need for written informed consent was waived by the Institutional Review Board, because there was no direct patient contact in this retrospective study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kaaki, B., Lewis, E., Takallapally, S. et al. Direct cost of hysterectomy: comparison of robotic versus other routes. J Robotic Surg 14, 305–310 (2020). https://doi.org/10.1007/s11701-019-00982-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-019-00982-7

Keywords

Search

Navigation