title: Robotic radical hysterectomy: comparison of outcomes and cost.
abstract: Operative and peri-operative outcomes, complications, and cost for radical hysterectomy for cervical cancer with negative sentinel nodes have been compared for robotics and laparotomy. Forty patients underwent radical hysterectomy with/out bilateral salpingo-oophorectomy, for early-stage cervical cancer. All cases were performed by one of two surgeons, at a single institution (16 robotic, 24 laparotomy). The data for the robotic group were collected prospectively and compared with data for a historic cohort who underwent laparotomy. The data included demographics and peri-operative variables including operative time, estimated blood loss, lymph node count, hospital stay, and complications. Additionally, real direct hospital cost was compared for both modalities. Patients undergoing robotic radical hysterectomy experienced longer operative time than the laparotomy cohort (351 min vs. 283 min P = 0.0001). Estimated blood loss was significantly lower for the robotic cohort than for the laparotomy cohort (106 ml vs. 546 ml P < 0.0001). The minor complication rate was lower in the robotic cohort than for laparotomy (19% vs. 63% P = 0.003). Average hospital stay for the robotic patients was significantly shorter than for those undergoing laparotomy (1.9 days versus 7.2 days, P < 0.0001). Lymph node retrieval did not differ between the two groups (robotic 15 nodes, laparotomy 13 nodes). The total average peri-operative costs for radical hysterectomy with lymphadenectomy completed via laparotomy was CAN $11,764 ± 6,790, and for robotic assistance 8,183 ± 1,089 (P = 0.002). When amortization of the robot was included, there remained a trend in favor of the robotic approach, but it did not reach statistical significance. Whereas robotics takes longer to perform than traditional laparotomy, it provides the patient with a shorter hospital stay, less need for pain medications, and reduced peri-operative morbidity. In addition real average hospital costs tend to be lower.
authors.affiliation: Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Road, Montreal, QC, H3T 1E2, Canada.
authors.forename: Darron
authors.initials: D
authors.lastname: Halliday
authors.affiliation: Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Road, Montreal, QC, H3T 1E2, Canada.
authors.forename: Susie
authors.initials: S
authors.lastname: Lau
authors.affiliation: Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Road, Montreal, QC, H3T 1E2, Canada.
authors.forename: Zvi
authors.initials: Z
authors.lastname: Vaknin
authors.affiliation: Department of Nursing, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada.
authors.forename: Claire
authors.initials: C
authors.lastname: Deland
authors.affiliation: Department of Radiology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Levental
authors.affiliation: Department of Diagnostic Medicine, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McNamara
authors.affiliation: Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Road, Montreal, QC, H3T 1E2, Canada.
authors.forename: Raphael
authors.initials: R
authors.lastname: Gotlieb
authors.affiliation: Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Road, Montreal, QC, H3T 1E2, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Kaufer
authors.affiliation: Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Road, Montreal, QC, H3T 1E2, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: How
authors.affiliation: Department of Pharmacy, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada.
authors.forename: Eva
authors.initials: E
authors.lastname: Cohen
authors.affiliation: Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Road, Montreal, QC, H3T 1E2, Canada. walter.gotlieb@mcgill.ca.
authors.forename: Walter H
authors.initials: WH
authors.lastname: Gotlieb
keywords: Cervical cancer; Complications, economical considerations; Cost; Laparotomy; Radical hysterectomy; Robotics