Robotically Assisted vs Laparoscopic Hysterectomy Among Women With Benign Gynecologic Disease
Robotically Assisted vs Laparoscopic Hysterectomy Among Women With Benign Gynecologic Disease
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DOI：
10.1001/jama.2013.186
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发表时间：
2013-02-20
影响因子：
120.7
通讯作者：
Hershman, Dawn L.
中科院分区：
文献类型：
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作者：
Wright, Jason D.;Ananth, Cande V.;Hershman, Dawn L.
重要性尽管机器人辅助子宫切除术治疗良性妇科疾病已有报道，但与其他子宫切除术途径相比，关于将该手术纳入实践，其并发症概况或其成本知之甚少。目的分析机器人辅助子宫切除术的使用情况，确定机器人手术的使用与腹部和腹腔镜子宫切除术的发生率之间的关系，并比较机器人辅助子宫切除术与腹部和腹腔镜子宫切除术的内部并发症。设计、环境和患者队列研究，对2007年至2010年在美国441家医院因良性妇科疾病接受子宫切除术的264 758名妇女进行研究。主要观察指标：机器人辅助子宫切除术的应用及其相关因素。对机器人子宫切除术妇女的并发症、输血、再手术、住院时间、死亡和费用进行了分析，并与腹部和腹腔镜手术进行了比较。结果机器人辅助子宫切除术的使用率从2007年的0.5%上升到2010年的9.5%。在同一时期，腹腔镜子宫切除术的发生率从24.3%上升到30.5%。第一例机器人辅助子宫切除术在医院进行三年后，机器人辅助子宫切除术占所有子宫切除术的22.4%。在进行机器人辅助子宫切除术的医院和没有进行机器人辅助子宫切除术的医院中，腹部子宫切除术的发生率都有所下降。在倾向评分匹配分析中，机器人辅助子宫切除术和腹腔镜子宫切除术的总并发症发生率相似（5.5% vs 5.3%；相对风险[RR]， 1.03; 95% CI, 0.86-1.24）。虽然接受机器人辅助子宫切除术的患者住院时间不太可能超过2天（19.6%对24.9%；RR, 0.78, 95% CI, 0.67-0.92），但输血需求（1.4%对1.8%；RR, 0.80; 95% CI, 0.55-1.16）和出院率（0.2%对0.3%；RR, 0.79; 95% CI, 0.35-1.76）相似。与腹腔镜子宫切除术相比，机器人辅助子宫切除术的总费用为每例2189美元（95% CI， 2030- 2349美元）。2007年至2010年间，机器人辅助子宫切除术在妇科良性疾病中的应用大幅增加。机器人辅助子宫切除术和腹腔镜子宫切除术的发病率相似，但机器人技术的使用导致了更多的成本。《美国医学协会杂志》上。2013年;309 (7): 689 - 698 www.jama.com
Importance Although robotically assisted hysterectomy for benign gynecologic conditions has been reported, little is known about the incorporation of the procedure into practice, its complication profile, or its costs compared with other routes of hysterectomy.Objectives To analyze the uptake of robotically assisted hysterectomy, to determine the association between use of robotic surgery and rates of abdominal and laparoscopic hysterectomy, and to compare the in-house complications of robotically assisted hysterectomy vs abdominal and laparoscopic procedures.Design, Setting, and Patients Cohort study of 264 758 women who underwent hysterectomy for benign gynecologic disorders at 441 hospitals across the United States from 2007 to 2010.Main Outcome Measures Uptake of and factors associated with utilization of robotically assisted hysterectomy. Complications, transfusion, reoperation, length of stay, death, and cost for women who underwent robotic hysterectomy compared with both abdominal and laparoscopic procedures were analyzed.Results Use of robotically assisted hysterectomy increased from 0.5% in 2007 to 9.5% of all hysterectomies in 2010. During the same time period, laparoscopic hysterectomy rates increased from 24.3% to 30.5%. Three years after the first robotic procedure at hospitals where robotically assisted hysterectomy was performed, robotically assisted hysterectomy accounted for 22.4% of all hysterectomies. The rates of abdominal hysterectomy decreased both in hospitals where robotic-assisted hysterectomy was performed as well as in those where it was not performed. In a propensity score-matched analysis, the overall complication rates were similar for robotic-assisted and laparoscopic hysterectomy(5.5% vs 5.3%; relative risk [RR], 1.03; 95% CI, 0.86-1.24). Although patients who underwent a robotic-assisted hysterectomy were less likely to have a length of stay longer than 2 days (19.6% vs 24.9%; RR, 0.78, 95% CI, 0.67-0.92), transfusion requirements (1.4% vs 1.8%; RR, 0.80; 95% CI, 0.55-1.16) and the rate of discharge to a nursing facility (0.2% vs 0.3%; RR, 0.79; 95% CI, 0.35-1.76) were similar. Total costs associated with robotically assisted hysterectomy were $2189 (95% CI, $2030-$2349) more per case than for laparoscopic hysterectomy.Conclusions and Relevance Between 2007 and 2010, the use of robotically assisted hysterectomy for benign gynecologic disorders increased substantially. Robotically assisted and laparoscopic hysterectomy had similar morbidity profiles, but the use of robotic technology resulted in substantially more costs. JAMA. 2013;309(7):689-698 www.jama.com