According to a 2011 article "Every year 600,000 hysterectomies are performed, but only 15% are performed using a minimally invasive technique." The article goes on to say, and I'm paraphrasing here. That robotic doesn't have a clear advantage over standard lap BUT IT DOES HAVE A CLEAR ADVANTAGE OVER OPEN.
Furthermore they go on to say that often there are factors that prohibit standard lap procedures. ISRG's market opportunity is the 85%+ of these procedures that are not currently done as MIS and/or include factors that prohibit standard lap. This is a huge market and that overall opportunity has not diminished. standard lap has been around for a long time, if it was going to capture a dominant market share it would have already happened. Anyone who thinks that there is going to be some huge resurgence in the number of standard lap surgeons who are going to soak up all this procedure volume, is just kidding themselves.
MIS will replace the vast majority of open hysterectomy over the next 10 years, and that means robotic MIS, not standard lap. The bigger problem for surgeons is that surgical intervention in general is becoming less common for hysterectomy and other diseases. The pie is ISRG's to take but the pie may be shrinking. Still there is a lot of pie in ISRG's future. For the record, less surgical intervention may be a very positive thing for the patients, but that's not my call to make.
In March 2013 the American Board of Gynecology stated that robotic hysterectomy should not be used in the majority of cases. Their is a clear reason for this. Hysterectomy can be performed vaginally, which is less invasive then abdominally. Davinci is an Abdominal surgery. It should only potentially be used on complex hysterectomy that cannot be performed vaginally, and only when their is not a skilled laproscopic surgeon available that can perform the manual surgery at the lower cost. What you have seen since this statement and the release of other studies is the realization by small hospitals that they are butchering women by perfoming robotic surgery when the non invasive vaginal is an option. oops.
You are overstating what was said and mixing apples with oranges. There was nothing said about "butchering" patients. The problem with small hospitals is not specific to robotic. Surgeons who do not do a high volume of similar procedures USING ANY MODE OF SURGERY can not become or stay proficient. So a patient is just as likely to have a bad outcome from a lap surgeon who has only done 5 procedures as a robotic surgeon, maybe more so. Ditto if they only do a few similar procedures per year.
As far as the ABG recommendation, as I recall it was based primarily on the cost. The cost difference of robotic is based on the initial cost of the robot. If the hospital has to have this to do the more complex cases, then they aren't saving any money by not using it on less complex cases. It also ignores the fact that patients have a choice and they are choosing to go to the hospitals that have robots, thus the hospital is undoubtedly benefiting economically from their daVinic purchase. Most studies criticizing robotic are not claiming it is inferior, only that it is not superior enough to justify the added cost, but as I pointed out, once the hospital has invested in the machine for other procedures, they save nothing by not using it.
Most the the stats used as a basis for these comparisons include the early learning curve for this robotic procedure which is fairly new. Starting from what most critics claim is at least non-inferior outcomes robotic outcomes have already improved and will continue to do so. 10 years from now there will not be a high volume of new surgeons learning standard lap techniques.