title: Introducing robotic surgery into an endometrial cancer service--a prospective evaluation of clinical and economic outcomes in a UK institution.
abstract: BACKGROUND
  We have assessed how the introduction of robotics in a publicly funded endometrial cancer service affects clinical and economic outcomes.
  
  
  METHODS
  The study included 196 women. Costs were divided into those for wards, high dependency, staffing, theatres, pharmacy, blood products, imaging, pathology and rehabilitation. Capital depreciation was included.
  
  
  RESULTS
  Prior to the introduction of robotics, 78/130 (60.0%) cases were performed open, compared to 17/66 (25.8%) afterwards (p < 0.0001). The median operative time increased 37 min (95% CI 17-55 min; p = 0.0002); the median blood loss was 55 ml lower (95% CI 0-150 ml; p = 0.0181); the stay was 2 days shorter (95% CI 1-3; p < 0.0001). Complications reduced from 64/130 (49.2%) to 19/66 (28.8%) (p = 0.0045). Costs reduced from £11 476 to £10 274 (p = 0.0065). Conversions for 'straight stick' surgery were 18.2% (14/77) compared to 0.0% (0/24) for robotics (p = 0.0164).
  
  
  CONCLUSIONS
  Introducing robotics resulted in fewer laparotomies, shorter stays, fewer complications and lower costs.
authors.affiliation: Department of Gynaecological Oncology, Royal Marsden Hospital, London, UK.|Department of Gynaecological Oncology, St George's Hospital, London, UK.
authors.forename: Thomas E J
authors.initials: TE
authors.lastname: Ind
authors.affiliation: Finance Department, Royal Marsden Hospital, London, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Marshall
authors.affiliation: Department of Anaesthesia, Royal Marsden Hospital, London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hacking
authors.affiliation: Department of Gynaecological Oncology, Royal Marsden Hospital, London, UK.
authors.forename: Michelle
authors.initials: M
authors.lastname: Harris
authors.affiliation: Directorate, Royal Marsden Hospital, London, UK.
authors.forename: Liz
authors.initials: L
authors.lastname: Bishop
authors.affiliation: Department of Gynaecological Oncology, Royal Marsden Hospital, London, UK.|Department of Gynaecological Oncology, St George's Hospital, London, UK.
authors.forename: Desmond
authors.initials: D
authors.lastname: Barton
authors.affiliation: Department of Gynaecological Oncology, Royal Marsden Hospital, London, UK.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Bridges
authors.affiliation: Department of Gynaecological Oncology, Royal Marsden Hospital, London, UK.
authors.forename: John H
authors.initials: JH
authors.lastname: Shepherd
authors.affiliation: Department of Gynaecological Oncology, Royal Marsden Hospital, London, UK.
authors.forename: Marielle
authors.initials: M
authors.lastname: Nobbenhuis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000601:surgery*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics / Q000379:methods*
keywords: complications; economic evaluation; endometrial cancer; laparoscopy; robotic surgery
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