Department of Gynecology and Gynecological Oncology, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium.
Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium.
Int J Med Robot. 2022 Feb;18(1):e2343. doi: 10.1002/rcs.2343. Epub 2021 Oct 26.
Economic data and the clinical impact of introducing robotic-assisted hysterectomy in a European setting are scarce with conflicting findings.
In this retrospective cohort study, the cost and complication rate of the different approaches of hysterectomy are investigated, both benign and (pre)malignant indications were included.
844 patients were included: 323 (38.3%) patients underwent robotic-assisted hysterectomy (RAH), 317 (37.5%) total abdominal hysterectomy (TAH), and 204 (24.2%) total laparoscopic hysterectomy (TLH). TAH dropped from 67.2% to 25.5% of procedures, whilst RAH rose to 41.8% of cases. The total hospitalisation cost was for RAH €5208.39 (±€916.91), for TAH €5846.61 (±€4464.37) and for TLH €3790.06 (±€1267.05). The postoperative complication rate of TAH (9.1%) was significantly higher in comparison with TLH and RAH (5.4% and 3.1%, respectively, p = 0.005).
RAH has replaced TAH in most cases, especially for large uteri, early-stage endometrial cancer and in selected endometriosis cases, resulting in reduced morbidity with lower hospitalisation costs. The indications for TLH remained, including menorrhagia, adenomyosis and persistent cervical dysplasia.
在欧洲环境下，关于引入机器人辅助子宫切除术的经济数据和临床影响较为匮乏，且存在相互矛盾的发现。
在这项回顾性队列研究中，我们研究了不同子宫切除术方法的成本和并发症发生率，包括良性和（前）恶性指征。
共纳入 844 名患者：323 名（38.3%）患者接受了机器人辅助子宫切除术（RAH），317 名（37.5%）患者接受了全腹部子宫切除术（TAH），204 名（24.2%）患者接受了全腹腔镜子宫切除术（TLH）。TAH 的手术比例从 67.2%下降至 25.5%，而 RAH 的手术比例上升至 41.8%。RAH 的总住院费用为 5208.39 欧元（±916.91 欧元），TAH 的总住院费用为 5846.61 欧元（±4464.37 欧元），TLH 的总住院费用为 3790.06 欧元（±1267.05 欧元）。TAH 的术后并发症发生率（9.1%）明显高于 TLH 和 RAH（分别为 5.4%和 3.1%，p=0.005）。
RAH 已取代 TAH 成为大多数情况下的首选术式，尤其是对于大子宫、早期子宫内膜癌和特定的子宫内膜异位症病例，降低了发病率并降低了住院费用。TLH 的适应证仍然存在，包括月经过多、子宫腺肌病和持续性宫颈发育不良。
