Impact of Increased Robotic Surgery for Patients Submitted to Hysterectomy: Considerations for the Italian Hospitals

OBJECTIVES: Publications agree on considering the key contribution of robotics in increasing the mininvasive surgery in the gynecology area, due to the ease of the robotics vs the laparoscopic approach. We aim to analyze the benefits of increased adoption of robotics in hysterectomies in Italian hospitals.

METHODS: The number of hysterectomies in Italy has been detected from the Italian National Outcome Plan. The average Length of Stay (LOS) was identified from the Ministry of Health report. The hospital daily costs have been detected from the literature. A literature review has been conducted to observe the use of robotic surgery in the United States (from 2000 until 2017 the percentage moved from 0.5% to 20% out of total hysterectomies). Considering the current number of hospitals with a robotic machine in Italy (> 100), it was reasonable to expect a switch of 10% from open to robotic hysterectomies in the next years in Italy.

RESULTS: Hysterectomies performed in Italy in 2022 are 55,542. At least 50% of total hysterectomies are still performed as open procedures. By switching 2,700 procedures to robotic surgery and considering that LOS for open vs robotic procedures is a 6-day vs 3-day LOS, more than 8,000 bed-days can be saved. The saving related to the decreased LOS is €1,350/hospitalization from the point of view of the hospital (> € 3,6 mln total).

CONCLUSIONS: The results stress the positive impact robotics can have. Anyway, it is known that the cost (not considered in this analysis) to implement robotics can be a barrier but, on the other hand, the volume of procedures and skilled surgical teams can make this a valuable innovation. Thus, further and detailed investigations are necessary to deepen all the elements that can make robotic surgery a sustainable investment in the Italian Healthcare System.