Robot-assisted laparoscopic myomectomy versus abdominal myomectomy: A comparison of short-term surgical outcomes and immediate costs

Abstract

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/m 2) versus 28.3 ± 6.95 kg/m 2 (90% CR 21.50–42.80 kg/m 2), 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 $30 084.20 ± $6689.29 [90% CR $22 939.81–$45 588.22] vs mean $13 400.62 ± $7747.26 [90% CR $8703.20–$26 771.22, 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: $13 181.39 ± $10 752.00 (90% CR $1081.76–$37 396.03) versus $7015.24 ± $3467.97 (90% CR $2492.48–$10 394.83, 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.