STUDY OBJECTIVE: To compare surgical outcomes of myomectomy by robot-assisted laparoscopy with those performed by traditional laparotomy and to analyze the financial impact of these 2 approaches. DESIGN: Retrospective case-matched analysis (Canadian Task Force classification III). SETTING: University teaching hospital. PATIENTS: A total of 58 patients with symptomatic leiomyomata. INTERVENTION: Myomectomy by robot-assisted laparoscopy or traditional laparotomy was administered. MEASUREMENTS AND MAIN RESULTS: An equal number of case-matched patients based on age, body mass index, and myoma weight were analyzed in each group. Among these 3 variables, there were no statistically significant differences between the robotic and laparotomy groups. Mean age was 36.59 +/- 4.93 years (95% CI 34.71-38.46 years) versus 34.86 +/- 4.41 years (95% CI 33.18-36.54 years), mean body mass index was 25.22 +/- 3.85 kg/m(2) (90% central range [CR] 20.30-31.20 kg/m2) versus 28.3 +/- 6.95 kg/m2 (90% CR 21.50-42.80 kg/m2), and mean myoma weight was 227.86 +/- 247.54 g (90% CR 11.60-680.00 g) versus 223.76 +/- 228.28 g (90% CR 11.50-660.00 g), respectively. Patients with robot-assisted laparoscopic myomectomy had decreased estimated blood loss (mean 195.69 +/- 228.55 mL [90% CR 50.00-700.00 mL] vs mean 364.66 +/- 473.28 mL [90% CR 75.00-1550.00 mL]) and length of stay (mean 1.48 +/- 0.95 days [90% CR 1.00-3.00 days] vs mean 3.62 +/- 1.50 days [90% CR 3.00-8.00 days]) when compared with the laparotomy group. Both of these differences were statistically significant at p <.05. Operative times were significantly longer in the robotic group: mean 231.38 +/- 85.10 minutes (95% CI 199.01-263.75 minutes) versus mean 154.41 +/- 43.14 minutes (95% CI 138.00-170.82 minutes, p <.05) in the laparotomy group. Complication rates were higher in the laparotomy group. Professional charges (mean $5946.48 +/- $1447.17 [90% CR $4034.46-$8937.00] vs mean $4664.48 +/- $642.11 [90% CR $3944.36-$6010.90, p <.0002]) and hospital charges (mean $30084.20 +/- $6689.29 [90% CR $22939.81-$45588.22] vs mean $13400.62 +/- $7747.26 [90% CR $8703.20-$26771.22, p <.0001]) were statistically higher for the robotic group. Although professional reimbursement was not significantly different between groups (mean $2263.02 +/- $1354.97 [90% CR $0.00- $4831.08] versus mean $1841.99 +/- $827.51 [90% CR $0.00-$3376.97, p = .2831]), mean hospital reimbursement rates for the robotic group were significantly higher: $13181.39 +/- $10752.00 (90% CR $1081.76-$37396.03) versus $7015.24 +/- $3467.97 (90% CR $2492.48-$10394.83, p = .0372). CONCLUSION: As a new technology, it is not unexpected that a robotic approach to myomectomy costs more than a traditional laparotomy. On the other hand, decreased estimated blood loss, complication rates, and length of stay with the robotic approach in the end may prove to have a significant societal benefit that will outweigh upfront financial impact.
STUDY OBJECTIVE: To compare surgical outcomes of myomectomy by robot-assisted laparoscopy with those performed by traditional laparotomy and to analyze the financial impact of these 2 approaches. DESIGN: Retrospective case-matched analysis (Canadian Task Force classification III). SETTING: University teaching hospital. PATIENTS: A total of 58 patients with symptomatic leiomyomata. INTERVENTION: Myomectomy by robot-assisted laparoscopy or traditional laparotomy was administered. MEASUREMENTS AND MAIN RESULTS: An equal number of case-matched patients based on age, body mass index, and myoma weight were analyzed in each group. Among these 3 variables, there were no statistically significant differences between the robotic and laparotomy groups. Mean age was 36.59 +/- 4.93 years (95% CI 34.71-38.46 years) versus 34.86 +/- 4.41 years (95% CI 33.18-36.54 years), mean body mass index was 25.22 +/- 3.85 kg/m(2) (90% central range [CR] 20.30-31.20 kg/m2) versus 28.3 +/- 6.95 kg/m2 (90% CR 21.50-42.80 kg/m2), and mean myoma weight was 227.86 +/- 247.54 g (90% CR 11.60-680.00 g) versus 223.76 +/- 228.28 g (90% CR 11.50-660.00 g), respectively. Patients with robot-assisted laparoscopic myomectomy had decreased estimated blood loss (mean 195.69 +/- 228.55 mL [90% CR 50.00-700.00 mL] vs mean 364.66 +/- 473.28 mL [90% CR 75.00-1550.00 mL]) and length of stay (mean 1.48 +/- 0.95 days [90% CR 1.00-3.00 days] vs mean 3.62 +/- 1.50 days [90% CR 3.00-8.00 days]) when compared with the laparotomy group. Both of these differences were statistically significant at p <.05. Operative times were significantly longer in the robotic group: mean 231.38 +/- 85.10 minutes (95% CI 199.01-263.75 minutes) versus mean 154.41 +/- 43.14 minutes (95% CI 138.00-170.82 minutes, p <.05) in the laparotomy group. Complication rates were higher in the laparotomy group. Professional charges (mean $5946.48 +/- $1447.17 [90% CR $4034.46-$8937.00] vs mean $4664.48 +/- $642.11 [90% CR $3944.36-$6010.90, p <.0002]) and hospital charges (mean $30084.20 +/- $6689.29 [90% CR $22939.81-$45588.22] vs mean $13400.62 +/- $7747.26 [90% CR $8703.20-$26771.22, p <.0001]) were statistically higher for the robotic group. Although professional reimbursement was not significantly different between groups (mean $2263.02 +/- $1354.97 [90% CR $0.00- $4831.08] versus mean $1841.99 +/- $827.51 [90% CR $0.00-$3376.97, p = .2831]), mean hospital reimbursement rates for the robotic group were significantly higher: $13181.39 +/- $10752.00 (90% CR $1081.76-$37396.03) versus $7015.24 +/- $3467.97 (90% CR $2492.48-$10394.83, p = .0372). CONCLUSION: As a new technology, it is not unexpected that a robotic approach to myomectomy costs more than a traditional laparotomy. On the other hand, decreased estimated blood loss, complication rates, and length of stay with the robotic approach in the end may prove to have a significant societal benefit that will outweigh upfront financial impact.
Authors: James H Segars; Estella C Parrott; Joan D Nagel; Xiaoxiao Catherine Guo; Xiaohua Gao; Linda S Birnbaum; Vivian W Pinn; Darlene Dixon Journal: Hum Reprod Update Date: 2014-01-08 Impact factor: 15.610