title: Outcomes and cost comparisons after introducing a robotics program for endometrial cancer surgery.
abstract: OBJECTIVE
  To evaluate the effect of introducing a robotic program on cost and patient outcome.
  
  
  METHODS
  This was a prospective evaluation of clinical outcome and cost after introducing a robotics program for the treatment of endometrial cancer and a retrospective comparison to the entire historical cohort.
  
  
  RESULTS
  Consecutive patients with endometrial cancer who underwent robotic surgery (n=143) were compared with all consecutive patients who underwent surgery (n=160) before robotics. The rate of minimally invasive surgery increased from 17% performed by laparoscopy to 98% performed by robotics in 2 years. The patient characteristics were comparable in both eras, except for a higher body mass index in the robotics era (median 29.8 compared with 27.6; P<.005). Patients undergoing robotics had longer operating times (233 compared with 206 minutes), but fewer adverse events (13% compared with 42%; P<.001), lower estimated median blood loss (50 compared with 200 mL; P<.001), and shorter median hospital stay (1 compared with 5 days; P<.001). The overall hospital costs were significantly lower for robotics compared with the historical group (Can$7,644 compared with Can$10,368 [Canadian dollars]; P<.001) even when acquisition and maintenance cost were included (Can$8,370 compared with Can$10,368; P=.001). Within 2 years after surgery, the short-term recurrence rate appeared lower in the robotics group compared with the historic cohort (11 recurrences compared with 19 recurrences; P<.001).
  
  
  CONCLUSIONS
  Introduction of robotics for endometrial cancer surgery increased the proportion of patients benefitting from minimally invasive surgery, improved short-term outcomes, and resulted in lower hospital costs.
  
  
  METHODS
  II.
authors.affiliation: Jewish General Hospital, Quebec, Canada.
authors.forename: Susie
authors.initials: S
authors.lastname: Lau
authors.forename: Zvi
authors.initials: Z
authors.lastname: Vaknin
authors.forename: Agnihotram V
authors.initials: AV
authors.lastname: Ramana-Kumar
authors.forename: Darron
authors.initials: D
authors.lastname: Halliday
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Franco
authors.forename: Walter H
authors.initials: WH
authors.lastname: Gotlieb
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D016889:Endometrial Neoplasms / Q000191:economics / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data; D011446:Prospective Studies; D012189:Retrospective Studies; D012371:Robotics / Q000191:economics / Q000706:statistics & numerical data*; D016896:Treatment Outcome