Impact of Reduced Robotic Forceps Surgery on the Cost of Robotic Hysterectomy

Abstract This retrospective observational cohort study compared clinical outcomes of reduced robotic forceps surgery (RRFS) using new multifunctional forceps and barbed sutures. Included were 121 patients who underwent robotic hysterectomy at the Cancer Institute Hospital of the Japanese Foundation for Cancer Research in Japan between January 2020 and July 2024. Surgeries were categorized into three groups based on number and type of forceps and sutures used: Group A (n = 40), use of five robotic forceps and standard absorbable suture; Group B (n = 38), use of four robotic forceps and unidirectional barbed suture; and Group C (n = 43), use of three robotic forceps including new multifunctional forceps and unidirectional barbed suture. There were no significant between-group differences in baseline characteristics such as age, body mass index, parity, and prior abdominal surgeries. Surgical outcomes showed no significant differences in total operation time or estimated blood loss. However, Group C had significantly shorter console time, vaginal cuff suture time, and hospital stay than Group A. No intraoperative complications occurred, nor were postoperative complications among the groups within three months significantly different. Average cost per case for robotic forceps and sutures was highest in Group A and lowest in Group C, resulting in a maximum cost reduction of US$305.92 per case. These findings suggest that RRFS utilizing new multifunctional forceps and barbed sutures can reduce costs without compromising surgical safety or efficiency, potentially helping to address concerns about the rising costs of robotic surgery. However, the realization of RRFS will involve a learning curve for mastering the procedure.