title: Laparoscopic and robot-assisted hysterectomy for uterine cancer: a comparison of costs and complications.
abstract: OBJECTIVE
  Increasingly, robotic surgery is being used for total hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection for uterine cancer. The purpose of this study was to compare the costs and complications among women undergoing robotic and laparoscopic hysterectomy for uterine cancer.
  
  
  METHODS
  We carried out a cohort study using the Nationwide Inpatient Sample (NIS) database between 2008 and 2012 on all women diagnosed with uterine cancer, classifying women as either laparoscopically or robotically treated, excluding laparotomies or vaginal approaches. Logistic regression analyses were used to evaluate the adjusted effect of surgical approach on complication rates.
  
  
  RESULTS
  There were 10,347 women who underwent hysterectomies for uterine cancer either laparoscopically (39%) or robotically (61%). The rate of robotic surgery consistently increased over the 5 year period. Women undergoing robotic surgery had more comorbid conditions (diabetes, hypertension, cardiovascular disease, renal disease, obesity or morbid obesity, and pulmonary disease). In adjusted analyses, women undergoing robotic surgery were more likely to have a lymph node dissection (73.01% vs 66.04%; P < .0001) and an admission lasting <3 days (86.01% vs 82.5%; P < .0001) compared with those undergoing laparoscopic surgery. The composite endpoint of any complication was similar between both cohorts (20.56% robotic vs 21.00% laparoscopy). In overall and subset analyses, robotic surgery was more costly, with median charges of $38,161.00 compared with $31,476.00 in those undergoing laparoscopic surgery (P < .0001).
  
  
  CONCLUSIONS
  Despite the considerably greater burden of comorbidities in those undergoing robotic surgery compared with laparoscopy, the former have shorter hospital admissions, a greater rate of lymph node dissection, and similar postoperative morbidity and mortality, albeit at greater total cost.
authors.affiliation: Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Zakhari
authors.affiliation: Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, McGill University, Montreal, QC, Canada.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Czuzoj-Shulman
authors.affiliation: Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, McGill University, Montreal, QC, Canada.
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Spence
authors.affiliation: Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada; Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, McGill University, Montreal, QC, Canada; Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada.
authors.forename: Walter H
authors.initials: WH
authors.lastname: Gotlieb
authors.affiliation: Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada; Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, McGill University, Montreal, QC, Canada. Electronic address: haim.abenhaim@gmail.com.
authors.forename: Haim A
authors.initials: HA
authors.lastname: Abenhaim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics; D007902:Length of Stay; D016015:Logistic Models; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012371:Robotics / Q000191:economics; D014594:Uterine Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*
keywords: cancer; laparoscopy; robotic surgery; uterine cancer