A Randomized Trial Comparing Vaginal and Laparoscopic Hysterectomy vs Robot-Assisted Hysterectomy

Abstract Study Objective To investigate the hospital cost and short-term clinical outcome of traditional minimally invasive hysterectomy vs robot-assisted hysterectomy in women primarily not considered candidates for vaginal surgery. Design Randomized controlled trial (Canadian Task Force classification I). Setting University Hospital in Sweden. Patients One hundred twenty-two women with uterine size ≤16 gestational weeks scheduled to undergo minimally invasive hysterectomy because of benign disease. Interventions Robot-assisted hysterectomy or traditional vaginal or laparoscopic minimally invasive hysterectomy. Measurements and Main Results All women underwent surgery as randomized. There were no demographic differences between the 2 groups. Vaginal hysterectomy was possible in 41% in the traditional minimally invasive group, at a mean hospital cost of $4579 compared with $7059 for traditional laparoscopic hysterectomy. This was reflected in a mean hospital cost of $993 more per robotic-assisted hysterectomy than for traditional minimally invasive hysterectomy when the robot was a preexisting investment. This hospital cost increased by $1607 when including investments and cost of maintenance. A per-protocol subanalysis comparing laparoscopy and robotics demonstrated similar hospital cost when the robot was a preexisting investment ($7059 vs $7016). Robotic-assisted hysterectomy was associated with less blood loss and fewer postoperative complications. Conclusion A similar hospital cost can be attained for laparoscopy and robotics when the robot is a preexisting investment. From the perspective of hospital costs, robotic-assisted hysterectomy is not advantageous for treating benign conditions when a vaginal approach is feasible in a high proportion of patients.