title: Clinical and cost comparisons for hysterectomy via abdominal, standard laparoscopic, vaginal and robot-assisted approaches.
abstract: BACKGROUND
  The goal of this study was to compare outcomes and costs of four methods of hysterectomy: abdominal, standard laparoscopic, vaginal and robot-assisted approaches.
  
  
  METHODS
  We conducted a retrospective medical chart review of 1474 consecutive hysterectomy patients with benign indications.
  
  
  RESULTS
  Implementation of a robotics program at our institution resulted in reductions in abdominal (33 percent to 8 percent) and laparoscopic (29 percent to 5 percent) hysterectomies. Robotic surgery demonstrated the least blood loss and shortest hospital stays (both p < 0.0001), despite greater case complexity. Overall complication rates were highest for abdominal procedures (14 percent) and similar across minimally invasive approaches (8 to 9 percent). Conversion rates were four times greater in laparoscopic than vaginal or robotic hysterectomy (p = 0.01). Vaginal hysterectomy, performed in the least complex cases, had the lowest major complication rate (1.5 percent) and lowest costs. Costs for robotic surgery were similar to abdominal and laparoscopic approaches when robots were not depreciated as direct surgical expenses.
  
  
  CONCLUSIONS
  Vaginal hysterectomy was the least expensive surgical option. Robotic surgery reduced morbidity, conversions and hospital stays even in complex cases, without incurring additional costs beyond purchase of the robotic system.
authors.forename: Laurie B
authors.initials: LB
authors.lastname: Landeen
authors.forename: Maria C
authors.initials: MC
authors.lastname: Bell
authors.forename: Helen B
authors.initials: HB
authors.lastname: Hubert
authors.forename: Larissa Y
authors.initials: LY
authors.lastname: Bennis
authors.forename: Siri S
authors.initials: SS
authors.lastname: Knutsen-Larson
authors.forename: Usha
authors.initials: U
authors.lastname: Seshadri-Kreaden
mesh_terms: D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics* / Q000379:methods*; D007045:Hysterectomy, Vaginal / Q000191:economics; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay; D012371:Robotics / Q000191:economics*; D013023:South Dakota