title: Comparative effectiveness of robotic versus laparoscopic hysterectomy for endometrial cancer.
abstract: OBJECTIVE
  Use of robotics in oncologic surgery is increasing; however, reports of safety and efficacy are from highly experienced surgeons and centers. We performed a population-based analysis to compare laparoscopic hysterectomy and robotic hysterectomy for endometrial cancer.
  
  
  METHODS
  The Perspective database was used to identify women who underwent a minimally invasive hysterectomy for endometrial cancer from 2008 to 2010. Morbidity, mortality, and cost were evaluated using multivariable logistic and linear regression models.
  
  
  RESULTS
  We identified 2,464 women, including 1,027 (41.7%) who underwent laparoscopic hysterectomy and 1,437 (58.3%) who underwent robotic hysterectomy. Women treated at larger hospitals, nonteaching hospitals, and centers outside of the northeast were more likely to undergo a robotic hysterectomy procedure, whereas black women, those without insurance, and women in rural areas were less likely to undergo a robotic hysterectomy procedure (P < .05 for all). The overall complication rate was 9.8% for laparoscopic hysterectomy versus 8.1% for robotic hysterectomy (P = .13). The adjusted odds ratio (OR) for any morbidity for robotic hysterectomy was 0.76 (95% CI, 0.56 to 1.03). After adjusting for patient, surgeon, and hospital characteristics, there were no significant differences in the rates of intraoperative complications (OR, 0.68; 95% CI, 0.42 to 1.08), surgical site complications (OR, 1.49; 95% CI, 0.81 to 2.73), medical complications (OR, 0.64; 95% CI, 0.40 to 1.01), or prolonged hospitalization (OR, 0.85; 95% CI, 0.64 to 1.14) between the procedures. The mean cost for robotic hysterectomy was $10,618 versus $8,996 for laparoscopic hysterectomy (P < .001). In a multivariable model, robotic hysterectomy was significantly more costly ($1,291; 95% CI, $985 to $1,597).
  
  
  CONCLUSIONS
  Despite claims of decreased complications with robotic hysterectomy, we found similar morbidity but increased cost compared with laparoscopic hysterectomy. Comparative long-term efficacy data are needed to justify its widespread use.
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. jw2459@columbia.edu
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Wilde
authors.forename: Sharyn N
authors.initials: SN
authors.lastname: Lewin
authors.forename: Abigail S
authors.initials: AS
authors.lastname: Charles
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Kim
authors.forename: Noah
authors.initials: N
authors.lastname: Goldman
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Herzog
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
mesh_terms: D016889:Endometrial Neoplasms / Q000601:surgery*; D005006:Ethnicity; D005260:Female; D006761:Hospitals / Q000145:classification; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D007348:Insurance, Health; D010535:Laparoscopy; D007902:Length of Stay; D008875:Middle Aged; D009657:North Carolina; D011183:Postoperative Complications; D012371:Robotics; D016896:Treatment Outcome