title: Tubal anastomosis by robotic compared with outpatient minilaparotomy.
abstract: OBJECTIVE
  To compare tubal anastomosis by robotic system compared with outpatient minilaparotomy.
  
  
  METHODS
  In this retrospective case-control study, women were identified by current procedural terminology code for tubal anastomosis. We included all cases of tubal anastomosis for reversal of a prior tubal ligation by either outpatient minilaparotomy or robotic system technique. Cases performed by laparoscopy without aid of the robot were excluded. Comparisons were based on Fisher's exact, chi(2), and Wilcoxon rank sum tests.
  
  
  RESULTS
  There were 26 cases of tubal anastomosis performed with the robot and 41 cases performed by outpatient minilaparotomy. The two groups were comparable in age, body mass index, and parity. Anesthesia time for the robotic technique (median with interquartile range) was 283 (267-290) minutes compared with 205 (170-230) minutes with outpatient minilaparotomy (P<.001). Surgical times for the robot and minilaparotomy were 229 (205-252) minutes and 181 (154-202) minutes respectively (P=.001). Hospitalization times, pregnancy, and ectopic pregnancy rates were not significantly different. The robotic technique was more costly. The median difference in costs of the procedures was $1,446 (95% confidence interval $1,112-1,812) (P<.001). The time to return to work was significantly shorter in the robotic system group by approximately 1 week (P=.013).
  
  
  CONCLUSIONS
  Robotic surgery for tubal anastomosis was successfully accomplished without conversion to laparotomy. The robotic technique for tubal anastomosis required significantly prolonged surgical and anesthesia times over outpatient minilaparotomy (P<or=.001). Costs were higher with the robotic technique. Return to normal activity was shorter with the robotic technique.
authors.affiliation: Departments of Obstetrics and Gynecology, the Cleveland Clinic, Cleveland, Ohio 44159, USA.
authors.forename: Allison K
authors.initials: AK
authors.lastname: Rodgers
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Goldberg
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Hammel
authors.forename: Tommaso
authors.initials: T
authors.lastname: Falcone
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D000758:Anesthesia / Q000379:methods; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003464:Culdoscopy / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007813:Laparotomy / Q000191:economics / Q000295:instrumentation* / Q000379:methods; D007902:Length of Stay; D008875:Middle Aged; D012189:Retrospective Studies; D012371:Robotics / Q000191:economics / Q000379:methods*; D018709:Statistics, Nonparametric; D013243:Sterilization Reversal / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome