title: Robot-assisted laparoscopic myomectomy versus abdominal myomectomy: a comparison of short-term surgical outcomes and immediate costs.
abstract: 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.
  
  
  METHODS
  Retrospective case-matched analysis (Canadian Task Force classification III).
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  A total of 58 patients with symptomatic leiomyomata.
  
  
  METHODS
  Myomectomy by robot-assisted laparoscopy or traditional laparotomy was administered.
  
  
  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).
  
  
  CONCLUSIONS
  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.affiliation: Department of Obstetrics and Gynecology, University of Michigan Medical Center, Women's Hospital, Ann Arbor, MI 48109, USA. aadvincu@umich.edu
authors.forename: Arnold P
authors.initials: AP
authors.lastname: Advincula
authors.forename: Xiao
authors.initials: X
authors.lastname: Xu
authors.forename: Suntrea
authors.initials: S
authors.lastname: Goudeau
authors.forename: Scott B
authors.initials: SB
authors.lastname: Ransom
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003365:Costs and Cost Analysis; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D018231:Leiomyomatosis / Q000601:surgery*; D008485:Medical Audit; D012189:Retrospective Studies; D012371:Robotics / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery*