From Robot to Disposables: Patterns of Industry Payments for Gynecologic Surgery

INTRODUCTION: Financial interactions between industry and clinicians are publicly reported in the U.S. Despite this transparency, the distribution of payments for gynecologic surgery, and how these patterns have evolved, has not been systematically described. Understanding payment patterns and trends may assist in evaluating potential implications on sustainability, practice patterns, and policy. OBJECTIVE: To evaluate industry-related payments for gynecologic surgery patterns and trends. METHODS: We analyzed publicly available data from the OpenPayments database for 2018–2024. Payments by product to U.S gynecologists, exceeding $500,000 in cumulative payments, were extracted and categorized by product class. We defined six categories: Disposable Surgical Instruments & Accessories, Energy Devices, Hysteroscopy Devices, Female Pelvic Medicine and Reconstructive Surgery (FPMRS) Devices, Radiofrequency Ablation Systems, and Robotic Systems. Descriptive statistics were used to summarize payment counts, values, and distribution across categories. Longitudinal trends were evaluated in absolute totals, proportional shares, and mean payments. RESULTS: Overall, 192,713 separate payments, totaling $81,583,074, were made for 21 surgical products to 23,162 gynecologists. The number of payments to individual physicians ranged from 1807 to 1, with a median of 3 payments (IQR 1–7) per physician. Of all payments, the highest share was directed towards Robotic Systems, comprising 35.7% of payments, followed by FPMRS Devices (27.2%), Hysteroscopy Devices (14.2%), Radiofrequency Ablation Systems (12.8%), Disposable Surgical Instruments & Accessories (6.1%), and Energy Devices (4.1%). While total payment amounts for Robotic Systems were the highest ($33.4M), Disposable Surgical Instruments & Accessories was the second highest paid category ($23.3M), and the category with the highest mean payment amounts ($1,809.5), followed by Robotic Systems with $460.9. When analyzed by year, total payment amounts increased steadily except for a decline in all categories in 2020 and a decline in most categories in 2024. The number of payments made was lowest in 2020 in all categories. During the study period, the share of payments for Robotic Systems and Disposable Surgical Instruments & Accessories remained stable, those for FPMRS Devices increased moderately, payments for Energy and Hysteroscopy Devices declined, and those for Radiofrequency Ablation Systems increased substantially. CONCLUSIONS: Industry payments for gynecologic surgery were highest for Robotic Systems and Disposable Surgical Instruments & Accessories, reflecting the U.S. health industry shift towards robotic surgery and single-use disposables. The share of payments for disposables is an underestimation, as many of the devices included in other categories are disposable as well. Payments for Radiofrequency Ablation devices have increased throughout the years, reflecting the emergence of two new products for the treatment of uterine fibroids, while payments to other categories have declined. The COVID-19 pandemic has impacted payment patterns with a sharp decline in the number and sum of payments.Figure 1Figure 2Figure 3