title: Flexible Carbon Dioxide Laser Fiber Versus Ultrasonic Scalpel in Robot-Assisted Laparoscopic Myomectomy.
abstract: OBJECTIVE
  To compare the effectiveness and safety of a flexible carbon dioxide (CO2) laser fiber to the ultrasonic scalpel when employed through a robotic surgical system.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Level II-2 evidence.
  
  
  METHODS
  Reproductive surgery practice at an academic hospital.
  
  
  METHODS
  Two hundred thirty-six women who had undergone robot-assisted laparoscopic myomectomy with either CO2 laser (n = 85) or the ultrasonic scalpel (n = 151).
  
  
  METHODS
  Robot-assisted laparoscopic myomectomy employing either a flexible CO2 laser fiber or a robotic ultrasonic scalpel as the primary energy tool.
  
  
  RESULTS
  Perioperative outcomes (estimated blood loss, operative time, length of hospital stay) of patients undergoing robot-assisted myomectomy with a flexible laser fiber or ultrasonic scalpel. Estimated blood loss and operative time were comparable (p = .95 and p = .55, respectively) between the 2 groups after adjusting for all confounders, whereas length of hospital stay remained significantly different (p = .004). Odds ratio for complications was 0.35 (95% confidence interval 0.08-1.56; p = .17), which denotes no difference in the risk for complications between the 2 groups.
  
  
  CONCLUSIONS
  Robot-assisted laparoscopic myomectomy with a flexible CO2 laser fiber is safe and has comparable operative outcomes to the ultrasonic scalpel. The small size and flexibility of this device allows robotic surgeons to employ safe focal energy without sacrificing operative ergonomics.
authors.affiliation: Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Souzana
authors.initials: S
authors.lastname: Choussein
authors.affiliation: Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Serene S
authors.initials: SS
authors.lastname: Srouji
authors.affiliation: Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Leslie V
authors.initials: LV
authors.lastname: Farland
authors.affiliation: Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: agargiulo@partners.org.
authors.forename: Antonio R
authors.initials: AR
authors.lastname: Gargiulo
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods; D053685:Laser Therapy / Q000379:methods; D054020:Lasers, Gas / Q000627:therapeutic use*; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D061646:Operative Time; D011183:Postoperative Complications; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000295:instrumentation / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D063186:Uterine Myomectomy / Q000295:instrumentation / Q000379:methods; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Carbon dioxide laser; Laparoscopic myomectomy; Robot-assisted myomectomy; Ultrasonic scalpel