What does this research mean for the field?

Minimally invasive approaches (conventional laparoscopy and robot-assisted surgery) for para-aortic lymph node dissection in gynecologic malignancies are clinically and economically superior to open laparotomy, which currently remains the predominant approach. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate and compare direct in-hospital costs, length of stay, and short-term morbidity among open laparotomy, conventional laparoscopy, and robot-assisted surgery for para-aortic lymph node dissection in gynecologic cancer.

December 11, 2025Journal of Robotic SurgeryOpen Access

Annual nationwide cost estimation and short-term outcomes after para-aortic lymph node dissection for gynecologic malignancies according to surgical approach (open, laparoscopic, and robotic)

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Authors

GDGiuseppe D’AngeloUniversity of Naples Federico II CDCam DuongAssistance Publique – Hôpitaux de Paris EBEnrica BentivegnaAssistance Publique – Hôpitaux de Paris

Discussion

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Implication

Retrospective cohort study reveals lower costs and morbidity with minimally invasive para-aortic dissection in gynecologic cancer, suggesting alternatives to open surgery.

Key Points

To evaluate and compare direct in-hospital costs, length of stay, and short-term morbidity among open laparotomy, conventional laparoscopy, and robot-assisted surgery for para-aortic lymph node dissection in gynecologic cancer.
Retrospective nationwide study of aggregate data from the 2023 French national hospital registry (PMSI) for public and non-profit hospital admissions coded for uterine or ovarian cancer undergoing para-aortic lymph node dissection (N = 1,076).
Patients were categorized by surgical approach: open laparotomy (OLP), conventional laparoscopy (CLS), public hospital robotic surgery (RAS-PUB), and a dedicated tertiary robotic benchmark unit (RAS-HEGP).
Direct costs combined national reimbursement tariffs with approach-specific disposable instrument expenses; primary endpoint was index-stay direct cost, with secondary endpoints of length of stay and severe morbidity (Severity Index 3–4).
Among 1,076 patients, 69.7% underwent OLP (n=750), 20.2% CLS (n=217), and 10.1% RAS (n=109; including 30 RAS-HEGP).
Severe morbidity was 33.1% for OLP compared to 6.0% for CLS, 8.9% for RAS-PUB, and 3.3% for RAS-HEGP; median length of stay for uncomplicated cases was 7.3 days (OLP), 3.3 days (CLS), 3.2 days (RAS-PUB), and 4.5 days (RAS-HEGP; p < 0.001).
Mean direct in-hospital costs were €8,823 for OLP, €3,222 for CLS, €4,099 for RAS-PUB, and €3,962 for RAS-HEGP; relative cost ratios were 0.37 for CLS, 0.46 for RAS-PUB, and 0.45 for RAS-HEGP compared to OLP (all exploratory p < 0.001).

Cite This Study

D’Angelo et al. (2025) studied this question.

synapsesocial.com/papers/6aa9fc382f1eb85158fc99e4 https://doi.org/10.1007/s11701-025-02978-y

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Implication

Retrospective cohort study reveals lower costs and morbidity with minimally invasive para-aortic dissection in gynecologic cancer, suggesting alternatives to open surgery.

Annual nationwide cost estimation and short-term outcomes after para-aortic lymph node dissection for gynecologic malignancies according to surgical approach (open, laparoscopic, and robotic)

Discussion

Member takes

Implication

Key Points

Cite This Study

Annual nationwide cost estimation and short-term outcomes after para-aortic lymph node dissection for gynecologic malignancies according to surgical approach (open, laparoscopic, and robotic)

Discussion

Member takes

Implication

Key Points

Cite This Study

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