Robotic adnexectomy compared with laparoscopy for adnexal mass.
OBJECTIVE
To evaluate whether the application of robotic technology in the performance of adnexectomy resulted in benefits for the patient when compared with patients operated by laparoscopy.


METHODS
Evaluation of 85 patients undergoing robotic adnexectomy and comparison with a group of 91 patients operated on by laparoscopy during the same period of time and by the same surgeons. Patients were compared by age, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status classification, indications, unilateral compared with bilateral adnexectomy, adhesions, size or weight or both of the adnexal mass, and previous abdominal or pelvic surgery. Univariate and multivariate analysis was used to determine factors favorable to each technique. Comparison between the groups was evaluated using the Fisher exact test from a one-way analysis of variance.


RESULTS
The robotic group had an increased number of obese (BMI 30 or more) and higher anesthetic risk (ASA classification 2 and 3) patients as compared with laparoscopy patients. The mean operating time was 12 minutes longer in the robotic group (P=.01). The mean blood loss (80 mL robotic, 71 mL laparoscopic), length of hospital stay (0.15 days robotic, 0.28 days laparoscopic), intraoperative complications (1% robotic, 2% laparoscopic), and postoperative complications (12% robotic, 11% laparoscopic) were similar in both groups.


CONCLUSIONS
: Laparoscopy and robotics provided similar results for the performance of adnexectomy, with similar blood loss, intraoperative and postoperative complications, and length of hospital stay. Robotics mean operating time was 12 minutes longer.


METHODS
II.
Magrina
Javier F
JF
From the Department of Gynecology, Mayo Clinic, Phoenix, Arizona; La Paz University Hospital, Madrid, Spain; and Hospital del Mar, Barcelona, Spain.
Espada
Mercedes
M
Munoz
Raquel
R
Noble
Brie N
BN
Kho
Rosanne M C
RMC
D000291:Adnexal Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome
Canis M, Botchorishvili R, Manhes H, Wattiez A, Mage G, Pouly JL, et al. Management of adnexal masses: role and risk of laparoscopy. Semin Surg Oncol 2000;19:28–35.
Mettler L. The cystic adnexal mass: patient selection, surgical techniques and long-term follow-up. Curr Opin Obstet Gynecol 2001;13:389–97.
Buchweitz O, Matthias S, Muller-Steinhardt M, Malik E. Laparoscopy in patients over 60 years old: a prospective, randomized evaluation of laparoscopic versus open adnexectomy. Am J Obstet Gynecol 2005;193:1364–8.
Pittaway DE, Takacs P, Bauguess P. Laparoscopic adnexectomy: a comparison with laparotomy. Am J Obstet Gynecol 1994;171:385–9.
American Society of Anesthesiologists (ASA) Physical Status Classification System. Page X, ASA Relative Value Guide 2000. Park Ridge (IL): American Society of Anesthesiologists; 2000.
Hidlebaugh D, O'Mara P, Conboy E. Salpingo-oophorectomy: clinical and financial analyses of laparoscopic and open techniques. J Am Assoc Gynecol Laparosc 1994;1:223–7.
Hidlebaugh DA, Vulgaropulos S, Orr R. Trends in oophorectomy by laparoscopic versus open techniques. J Am Assoc Gynecol Laparosc 1996;3:S17–8.
Magrina JF, Kho RM, Weaver AL, Montero RP, Magtibay PM. Robotic radical hysterectomy: comparison with laparoscopy and laparotomy. Gynecol Oncol 2008;109:86–91.
Vilos GA, Alshimmiri MM. Cost-benefit analysis of laparoscopic versus laparotomy salpingo-oophorectomy for benign tubo-ovarian disease. J Am Assoc Gynecol Laparosc 1995;2:299–303.
Magrina JF. Robotic surgery in gynecology. Eur J Gynaecol Oncol 2007;28:77–82.
Payne TN, Dauterive FR. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol 2008;15:286–91.
Kho RM, Hilger WS, Hentz JG, Magtibay PM, Magrina JF. Robotic hysterectomy: technique and initial outcomes [published erratum appears in Am J Obstet Gynecol 2007;197:332]. Am J Obstet Gynecol 2007;197:113 e1–4.
Akl MN, Magrina JF, Kho RM, Magtibay PM. Robotic appendectomy in gynaecological surgery: technique and pathological findings. Int J Med Robot 2008;4:210–3.