Comparison of cost and operative outcomes of robotic hysterectomy compared to laparoscopic hysterectomy across different uterine weights.

Abstract

Operative cost and outcomes between robotic and laparoscopic hysterectomy across different uterine weights. Retrospective cohort study including patients undergoing robotic and laparoscopic hysterectomy for benign disease at an Academic university hospital. One hundred and ninety six hysterectomies were identified (101 robotic versus 95 laparoscopic). Demographic and surgical characteristics were statistically equivalent. Robotic group had a higher body mass index (±SD) (32.9±6.5 versus 30.4±7.1, p 0.012) and more frequent history of adnexal surgery (12.9 versus 4.2%, p 0.031). Laparoscopic group had a higher number of concurrent salpingectomy (81 versus 66.3%, p 0.02). Estimated blood loss did not differ between procedures. Compared to robotic hysterectomies, laparoscopic procedures added 47min (CI: 31-63min; p<0.001) of operative time, costed $1648 more (CI: 500-2797; p=0. 005) and had triple the odds of having an overnight admission (OR=2.94 CI: 1.34-6.44; p=0.007). After stratification of cases by uterine weight, the mean operative time difference between the two groups in uteri between 750 and 1000g and in uteri >1000g was 81.3min (CI: 51.3-111.3, p<0.0001) and 70min (CI: 26-114, p<0.005), respectively, in favor of the robotic group. Mean direct cost difference in uteri between 750 and 1000g and uteri >1000g was 1859$ (CI: 629-3090, p<0.006) and 4509$ (CI: 377-8641, p<0.004), respectively, also in favor of the robotic group. In expert hands, robotic hysterectomy for uteri weighing more than 750g may be associated with shorter operative time and improved cost profile.