Cost Analysis When Open Surgeons Perform Minimally Invasive Hysterectomy

Background and Objective: The costs to perform a hysterectomy are widely variable. Our objective was to determine hysterectomy costs by route and whether tra-ditionally open surgeons lower costs when performing laparoscopy versus robotics. Methods: Hysterectomy costs including subcategories were collected from 2011 to 2013. Costs were skewed, so 2 statistical transformations were performed. Costs were compared by surgeon classification (open, laparoscopic, or robotic) and surgery route. Results: A total of 4,871 hysterectomies were performed: 34.2 % open, 50.7 % laparoscopic, and 15.1 % robotic. Lapa-roscopic hysterectomy had the lowest total costs (P .001). By cost subcategory, laparoscopic hysterectomy was lower than robotic hysterectomy in 6 and higher in 1. When performing robotic hysterectomy, open and robotic surgeon costs were similar. With laparoscopic hysterec-tomy, open surgeons had higher costs than laparoscopic surgeons for 1 of 2 statistical transformations (P .007). Open surgeons had lower costs performing laparoscopic hysterectomy than robotic hysterectomy with robotic maintenance and depreciation included (P .001) but similar costs if these variables were excluded. Conclusion: Although laparoscopic hysterectomy had lowest costs overall, robotics may be no more costly than laparoscopic hysterectomy when performed by surgeons who predominantly perform open hysterectomy