Using the Endo Stitch device in such procedures was associated with lowering overall hospitalization costs by approximately $1,800 and reducing OR time by approximately 40 minutes, on average, when compared to those same procedures performed with robotic assistance.
The results, presented at the American Association of Gynecologic Laparoscopists (AAGL) 40th Global Congress of Minimally Invasive Gynecology, also revealed that mean operating room time in cases where Covidiens Endo Stitch device was used in such procedures was about 20 minutes less, when compared to procedures where neither a robot nor an Endo Stitch device was utilized.
"In this tough economic environment, hospitals, payors and patients all feel pressure to reduce costs and increase efficiency in the operating room," said study co-presenter Stuart Hart, MD, FACOG, FACS, Co-Director, University of South Florida Center for the Advancement of Minimally Invasive Pelvic Surgery. "Minimally invasive procedures offer the potential to reduce pain and trauma to the body, as well as to enable quicker recovery resulting from smaller and fewer incisions. Despite the proven benefits, however, the vast majority of hysterectomies are still performed with open techniques."
Laparoscopic suturing is a vital skill for advanced laparoscopic surgeons, but it is considered difficult to master when using traditional manual techniques. Automated suturing devices, such as Covidiens Endo Stitch, assist in the process and have been shown to shorten the time needed to suture internal tissues through ports, when compared to other techniques.
"New technologies like automated suturing devices and surgical robots have made suturing inside the body easier, which may increase the number of surgeons who adopt laparoscopic techniques," said co-presenter Craig Sobolewski, MD, Chief, Division of Minimally Invasive Gynecologic Surgery, Duke University Medical Center. "While robot-assisted suturing has been shown to be clinically effective, this data indicates that automated suturing with the Endo Stitch device during total laparoscopic hysterectomy in benign cases can be associated with less expensive and more efficient outcomes when the choice is between the two different enabling intracorporeal suturing technologies."
According to the AAGL, fewer than 15% of the 600,000 hysterectomy procedures performed annually in the United States are done laparoscopically, largely due to lack of required training during a surgeons formal education program.1
"Covidien is committed to developing surgical instruments that enable minimally invasive surgery, while helping to reduce overall costs to the healthcare system." said Dean J Geraci, Director, Healthcare Economics and Reimbursement, Covidien. "We are encouraged by these study results and look forward to continued exploration of the clinical and economic impact of enabling laparoscopic technologies."
About the Study
The study was a retrospective data analysis that compared the reported overall hospital costs and OR time when utilizing the Endo Stitch device, versus using robotic techniques, during total laparoscopic hysterectomy in benign cases, as well as using neither the Endo Stitch device nor robotic techniques in such cases.
The study analyzed inpatient hospitalization data from January 1, 2009, to June 30, 2010, taken from Premiers Perspective™ Database (PPD). Multivariate analysis using Generalized Estimating Equations was used for the analysis, controlling for patient demographics and hospital characteristics. The analysis included clustering of patients receiving care from the same hospital.
A total of 5,731 patients were identified who underwent a total laparoscopic hysterectomy (primary ICD-9-CM code 68.41) without a primary diagnosis of cervical, uterine, ovarian or tubal cancers. Of those procedures, 13% (n=727) utilized the Endo Stitch device, 50% (n=2,853) used robotic assistance and 37% (n=2,151) used neither the Endo Stitch device nor robotic assistance during the procedure.
Outcomes were adjusted for patient age, race, severity of illness, co-morbidities, hospital bed-size, census region and teaching status, and clustering by provider. The Endo Stitch device use compared to robot use resulted in lower adjusted overall costs and less OR time: $7,820 vs. $9,689 (p=0.0096) and 173 minutes vs. 216 minutes (p = 0.0003), respectively.
Endo Stitch device use compared to neither devices used resulted in lower OR time: 173 minutes vs. 194 minutes (p=0.0022), respectively. As with other observational studies, some important factors may not have been controlled for in the analysis, therefore no direct causation can be definitively concluded.
Covidien is a leading global healthcare products company that creates innovative medical solutions for better patient outcomes and delivers value through clinical leadership and excellence. Covidien manufactures, distributes and services a diverse range of industry-leading product lines in three segments: Medical Devices, Pharmaceuticals and Medical Supplies. With 2011 revenue of $11.6 billion, Covidien has 41,000 employees worldwide in more than 65 countries, and its products are sold in over 140 countries. Please visit http://www.covidien.com to learn more about our business.
1 Preliminary Program 40th AAGL Global Congress of Minimally Invasive Gynecology. P. 11. Retrieved November 17, 2011 from the World Wide Web: http://viewer.zmags.com/publication/80faeaf8#/80faeaf8/10.
Posted by Sean Fenske, Editor-in-Chief, MDT