Approach to Hysterectomy Varies Despite Advances
Friday, March 29, 2013
Brent DuBeshter, M.D.
By age 65, one-third of women in the United States will have a hysterectomy, an operation to remove the uterus. Most women will undergo a traditional abdominal hysterectomy, despite advances in minimally invasive techniques that can improve patient outcomes, according to a new study published in the Journal of Gynecologic Surgery.
Brent DuBeshter, M.D., Director of Gynecologic Oncology at Highland Hospital and Director of Gynecologic Oncology at the University of Rochester Medical Center, led the study to determine how often surgeons utilized the robotic approach to hysterectomy. This minimally invasive technique requires just a few 8- to 12-millimeter incisions as opposed to traditional hysterectomy, which requires a 6- to 10-inch incision across the abdomen.
The study analyzed 22,073 hysterectomy cases in New York state in 2011 and found surgeons predominantly performed open abdominal procedures. However, the advent of robotic surgery in 2005 has increased access to an approach that is more beneficial to patients in many cases.
“The robotic technology gives more surgeons the opportunity to perform minimally invasive hysterectomies,” Dr. DuBeshter said, noting that few surgeons have become skilled in another minimally invasive technique – laparoscopic hysterectomy – since it was introduced more than 20 years ago. “As more surgeons receive robotics training, I suspect robotic hysterectomies will replace traditional procedures, particularly for uterine and other cancers.”
Of the nearly 2,500 hysterectomies performed on uterine cancer patients, 48 percent were done abdominally, 15 percent with laparoscopy and 35 percent with robotic technology. Overall, surgeons utilized robotics for hysterectomy only 13 percent of the time.
The study confirmed the benefits of minimally invasive (laparoscopic, robotic, vaginal) hysterectomy: Length of hospital stay following a minimally invasive procedure – about 1.6 days – was significantly shorter than length of stay for abdominal procedures, 3.9 days.
Highland Hospital performed the most hysterectomies (695) in the state followed by Memorial Sloan-Kettering Cancer Center (684) and Mt. Sinai Hospital (617) in New York City. The use of the robotic technique varied from 2 percent to 62 percent among the 10 institutions with the highest volumes. Approximately 55 percent of hysterectomies performed at Highland are done with one of the hospital’s two robotic surgical systems.
Cynthia Angel, M.D., Eugene Toy, M.D., and Sajeena Thomas, M.D. – also gynecologic oncologists at Highland – and J. Christopher Glantz, M.D., M.P.H., URMC Professor of Obstetrics and Gynecology, contributed to the study.