title: A randomized trial comparing vaginal and laparoscopic hysterectomy vs robot-assisted hysterectomy.
abstract: 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.
  
  
  METHODS
  Randomized controlled trial (Canadian Task Force classification I).
  
  
  METHODS
  University Hospital in Sweden.
  
  
  METHODS
  One hundred twenty-two women with uterine size ≤ 16 gestational weeks scheduled to undergo minimally invasive hysterectomy because of benign disease.
  
  
  METHODS
  Robot-assisted hysterectomy or traditional vaginal or laparoscopic minimally invasive hysterectomy.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Skåne University Hospital and Lund University, Lund, Sweden.
authors.forename: Celine
authors.initials: C
authors.lastname: Lönnerfors
authors.affiliation: Department of Obstetrics and Gynecology, Skåne University Hospital and Lund University, Lund, Sweden.
authors.forename: Petur
authors.initials: P
authors.lastname: Reynisson
authors.affiliation: Department of Obstetrics and Gynecology, Skåne University Hospital and Lund University, Lund, Sweden. Electronic address: jan.persson@med.lu.se.
authors.forename: Jan
authors.initials: J
authors.lastname: Persson
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000379:methods; D007045:Hysterectomy, Vaginal / Q000191:economics / Q000379:methods*; D010535:Laparoscopy / Q000191:economics / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology*; D065287:Robotic Surgical Procedures / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome
keywords: Hysterectomy; Laparoscopic hysterectomy; Minimally invasive surgery; Robot-assisted laparoscopy; Vaginal hysterectomy