The clinical and financial impact of introducing robotic-assisted hysterectomy in a tertiary referral centre: A direct cost analysis of consecutive hysterectomies during a decade

Background Economic data and the clinical impact of introducing robotic-assisted hysterectomy in a European setting are scarce with conflicting findings. Methods 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. Results 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 euro5208.39 (+/- euro916.91), for TAH euro5846.61 (+/- euro4464.37) and for TLH euro3790.06 (+/- euro1267.05). 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). Conclusions 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.