Journal: Obstetrics and Gynecology. 2010;116:685-93.

Authors: Barnett JC, Judd JP, Wu JM, Scales CD Jr, Myers ER, Havrilesky LJ.

Study from: Duke University, Durham, North Carolina

Problem: Robotic surgery has recently become popular, although the costs of robotic surgery are thought to be significantly higher than laparoscopic surgery. This study, compares the costs of laparoscopic, abdominal and robotic hysterectomy.

Study: The costs associated with robotic, laparoscopic, and abdominal hysterectomy were compared, including hospital and surgical costs, as well as lost income and caregiver costs (societal costs).

Results: The study calculations, which included hospital costs and societal costs, found that laparoscopic surgery was the least expensive approach. Abdominal surgery was the most expensive and robotic surgery was in between. Robotic surgery cost about $2,500 more per case due to the costs of the robot ($1.75 million), additional time needed for each surgery and the costs of disposable robotic equipment.

Authors’ Conclusions: Laparoscopy is the least expensive surgical approach for hysterectomy. Robotic is less costly than abdominal hysterectomy when the societal costs associated with recovery time are accounted for.

Dr. Parker’s Comments: Robotic surgery is being heavily promoted by the company that makes the robot and by surgeons who have been trained to do robotic surgery. However, it has been fairly clear that the robot is very expensive, the surgeries take longer and the disposable robotic instruments are also very expensive. Many of the gynecologists who have adopted robotic surgery were not accomplished laparoscopic surgeons, but are now able to perform minimally invasive surgery using the robot. While robotic surgery is more expensive than laparoscopic surgery, it is less expensive than abdominal surgery because it still provides a faster recovery and less time away from work and home.

(disclaimer – I have been doing laparoscopic surgery since 1987, and have been trained to do robotic surgery, but have only been performing this surgery for about two years with much fewer cases).

Hello Dr. Parker,

I was doing some research online and came across your website and looking at Laparoscopic and Robotic Myomectomy. But I have few questions for you, hope you would be able to answer it for me.

I am 27 years old and found out about the Fibroid when I just turned 26. The nurse, doctors, radiologist, everyone were surprised that for a young person like me has Fibroids.  And I do not have a family history of Fibroids either. Since, then I have been doing Ultrasound and regular checkup every 6 month with my doctor.  I have 2 big fibroids, one on the top of the Uterus and another behind or on the wall of the Uterus.  Since I am so young, there are so many complications, I have to think before choosing the Option.

Last week, my doctor told me, both fibroid have grown to the size of not quite as Soft ball but larger than BaseBall. And recommended I have the Laporoscopy Myomectomy done, as soon as I can.  Since, the bigger, it gets, harder and complicate for surgery.   This week, I went for second opinion and the doctor recommended/told me da Vinci myomectomy. I read a lot about it online too. But I am really confused now and scared too because I have never had any surgery before. Both has its advantage and disadvantages, I was wondering if you have suggestion for me. I called my regular doctor and told about da Vinci Myomectomy, she told me I am not the candidate for that since my fibroids are big. I have the surgery date scheduled in few weeks, I am getting more and more scared and worried, as to what I should do. What would be the good decision for me, since I plan on getting pregnant in the next few years when I am married?

I appreciate your time and opinion. Hope to get a reply from you.
Thanks,
A.

A,

Is the first doctor recommending a laparoscopic myomectomy (telescope through the navel) or an abdominal myomectomy (bikini incision)?   Laparoscopic myomectomy and robotic myomectomy are very similar and both have a faster recovery than abdominal myomectomy. It sounds like your doctor does not perform either laparoscopic or robotic myomectomy and is nervous about the size of the fibroids. The important thing with either of these procedures is to find a gynecologist who has a lot of experience and skill doing the procedure.

Bill Parker, MD

Thank you for the reply.   My regular doctor does the laparoscopic myomectomy. Because my fibroids are big, she can’t do the laparoscopic myomectomy. She said she has done many myomectomies, however I should ask more questions.

The procedure she will be performing on me is “myomectomy per Laparotomy” which is the abdominal myomectomy. I think I am going to do more research. And also waiting to find out, how often my doctor performs this procedures and complication, successes etc. I think she already has given answers to a part of these questions.

Thanks,  A.

A.

You should also ask the other doctor how many da Vinci (robotic) myomectomies they have done, how many for women with fibroids the size of yours, how many have gotten pregnant, how many complications they have had.  This is a relatively new procedure and some doctors are just learning.  You do not want them practicing on you!

Bill Parker, MD

For more information about laparoscopic and robotic myomectomy please see:

http://www.fibroidsecondopinion.com/laparoscopic-myomectomy/