title: Cost analysis when open surgeons perform minimally invasive hysterectomy.
abstract: OBJECTIVE
  The costs to perform a hysterectomy are widely variable. Our objective was to determine hysterectomy costs by route and whether traditionally open surgeons lower costs when performing laparoscopy versus robotics.
  
  
  METHODS
  Hysterectomy costs including subcategories were collected from 2011 to 2013. Costs were skewed, so 2 statistical transformations were performed. Costs were compared by surgeon classification (open, laparoscopic, or robotic) and surgery route.
  
  
  RESULTS
  A total of 4,871 hysterectomies were performed: 34.2% open, 50.7% laparoscopic, and 15.1% robotic. Laparoscopic hysterectomy had the lowest total costs (P < .001). By cost subcategory, laparoscopic hysterectomy was lower than robotic hysterectomy in 6 and higher in 1. When performing robotic hysterectomy, open and robotic surgeon costs were similar. With laparoscopic hysterectomy, open surgeons had higher costs than laparoscopic surgeons for 1 of 2 statistical transformations (P = .007). Open surgeons had lower costs performing laparoscopic hysterectomy than robotic hysterectomy with robotic maintenance and depreciation included (P < .001) but similar costs if these variables were excluded.
  
  
  CONCLUSIONS
  Although laparoscopic hysterectomy had lowest costs overall, robotics may be no more costly than laparoscopic hysterectomy when performed by surgeons who predominantly perform open hysterectomy.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Shepherd
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Kantartzis
authors.affiliation: Korea University Medical Center, Seoul, South Korea.
authors.forename: Ki Hoon
authors.initials: KH
authors.lastname: Ahn
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bonidie
authors.forename: Ted
authors.initials: T
authors.lastname: Lee
mesh_terms: D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007044:Hysterectomy / Q000191:economics* / Q000379:methods; D010535:Laparoscopy / Q000191:economics*; D012371:Robotics / Q000191:economics*; D014481:United States
keywords: Hysterectomy; Laparoscopy; Robotic-assisted laparoscopy