Paul-Dehlinger Richard, Vappereau Alexandra, Bras Alicia Le, Oliveira Joana, Favier Amelia, Belghiti Jeremy, Uzan Catherine, Durand-Zaleski Isabelle, Canlorbe Geoffroy
Department of Surgery and Oncological Gynecology, Pitié-Salpêtrière University Hospital, Paris, France; Intercommunal Hospital Center André Grégoire, Montreuil, France.
DRCI-URC Eco Ile-de-France (AP-HP), Assistance Publique-Hôpitaux de Paris, Paris, France.
J Gynecol Obstet Hum Reprod. 2025 Jun 13;54(7):102989. doi: 10.1016/j.jogoh.2025.102989.
Hysterectomy for benign pathologies is one of the most common gynecological surgeries. Over the past few years, robotic surgery has become an alternative to traditional surgery, but at a higher cost.
Calculate the cost-effectiveness of robot-assisted hysterectomy (RAH) compared with open hysterectomy (OH) for the purpose of supporting public decision-making, as well as the additional cost per major postoperative complication (ClavienDindo score ≥ 3) avoided one month after surgery robotic versus open surgery.
Single-center retrospective study including patients operated on for benign hysterectomy at La Pitié Salpêtrière hospital between January 2016 and December 2019: 24 by robotic approach, and 54 by open surgery. Comparison of robotic surgery to open. Calculation of a cost-effectiveness ratio (ICER). Use of the propensity score inverse weighting method to ensure comparability of groups.
Robotic surgery has a total cost of €7704 at 1 month per patient compared to €5301 for open surgery with an additional cost of € 828,621 per major postoperative complication avoided, longer operating time and an absence of significant difference in terms of complications and length of hospitalization.
In terms of cost-effectiveness, RAH had a high probability to be more expensive and more effective than OH. In the years to come, we can expect a development of robotic surgery with rationalization of the practice, with appropriate selection of patients for robotic surgery, development of outpatient surgery and a reduction in the cost of the equipment.
因良性病变进行子宫切除术是最常见的妇科手术之一。在过去几年中，机器人手术已成为传统手术的一种替代方式，但成本更高。
计算机器人辅助子宫切除术（RAH）与开放性子宫切除术（OH）相比的成本效益，以支持公共决策，以及术后1个月机器人手术与开放手术相比避免的每例主要术后并发症（Clavien-Dindo评分≥3）的额外成本。
单中心回顾性研究，纳入2016年1月至2019年12月在拉皮蒂埃-萨尔佩特里埃医院因良性子宫疾病接受手术的患者：24例行机器人手术，54例行开放手术。比较机器人手术与开放手术。计算成本效益比（ICER）。采用倾向评分逆加权法确保组间可比性。
机器人手术患者术后1个月的总成本为7704欧元，而开放手术为5301欧元，每避免一例主要术后并发症的额外成本为828,621欧元，手术时间更长，并发症和住院时间方面无显著差异。
在成本效益方面，RAH很可能比OH更昂贵但更有效。在未来几年，我们可以期待随着手术实践的合理化、对机器人手术患者的适当选择、门诊手术的发展以及设备成本的降低，机器人手术会有所发展。
