8776 Perioperative Outcomes of Robotic Versus Open Midline Specimen Extraction Fascial Site Closure

Abstract

<h3>Study Objective</h3> Laparoscopic sacrocolpopexy (SCP) is typically performed to repair advanced stage pelvic organ prolapse. Surgeons often opt to perform a supracervical hysterectomy (SCH) rather than total during combination SCP to avoid mesh erosions/infections. Tissue extraction is accomplished by extending a midline port site and may be closed by either a traditionally open or intra-abdominal robotic technique. This study aims to evaluate the outcomes of these two closures. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Academic-affiliated community hospital. <h3>Patients or Participants</h3> All patients (n=183) undergoing a robotic-assisted SCH, SCP, and midurethral sling placement by a single urogynecologist in which the uterus was extracted from an extended midline port between January 2021 and March 2022 were included in this study. <h3>Interventions</h3> Cases (n=105) of extraction sites closed via an intra-abdominal robotic approach were compared to controls (n=78) of a traditional open approach. <h3>Measurements and Main Results</h3> Casesand controls had similar operative times (251 vs 258 mins, p=0.35). Cases required less pain medication use in morphine milligram equivalents (MME) during the hospital stay (12.1 vs 18.4 MME, P<0.05). Body mass index (BMI) averages were also greater amongst cases (28.3 vs 26.3 kg/m², p<0.05). No difference was observed in other demographic data including age, race, and comorbid medical conditions. No statistical difference was noted comparing returns to the emergency department or hospital readmissions between groups. <h3>Conclusion</h3> Robotic and open fascial closure after tissue extraction requires similar operative times. Robotic closure has decreased pain requirements with similar complication profiles and was performed on patients with greater BMI reflecting surgeon bias for its use in obese patients. Surgeons should consider intra-abdominal robotic closure especially when patient body habitus makes secure fascial closure from an open approach more challenging.