The purpose of this study was to compare cost and outcomes between laparoscopy and robotic-assistance in women undergoing complex myomectomy.METHODS:
This is a retrospective cohort study of women undergoing minimally invasive myomectomy from January 2014 to December 2014. Women with dominant myoma diameter >8 cm and/or specimen weight >250 g and/or >5 myomata removed were compared by surgical modality.RESULTS:
The cohort consisted of 70 patients with 54% laparoscopic and 46% robotic myomectomies. The robotic group had lower rates of concomitant procedures (32% versus 2%, P=.014), mean (SD) specimen weights in grams (351.5 [417.6] versus 574.0 [525.5], P=.014), and mean (SD) operative time (ORT) in minutes (150 [62.9] versus 216.7 [84.8], P=.0006), but no difference in number of myomata removed (median [range] 4 [1–16] versus 4 [1–20], P=.057) or diameter of dominant myoma in centimeters (median [range] 8 [2–20] versus 10 [2–20], P=.18). Estimated blood loss (EBL) and complication rates were equivalent. The mean (SD) direct cost in dollars for robotic cases was lower (5,861.3 [2,273.9] versus 7,081.7 [3,373.5], P=.0402). Indirect costs did not differ. In a logistic regression model, cost increased with ORT, specimen weight, EBL, prior laparotomy, complications, and length of stay, but not by surgical modality.CONCLUSION:
In this pilot study of expert surgeons using their preferred modality for complex myomectomy, outcomes and costs were comparable. Costs were influenced by factors that increased surgical complexity and were contained in the robotics group. This preliminary data demonstrates a potential capacity for cost containment with the use of robotic surgery.