Laparoscopic Myomectomy Faster Than Robot-Assisted Surgery

Jenni Laidman

July 24, 2012

July 24, 2012 — Robotic myomectomy procedures take longer than laparoscopic myomectomies, but both procedures have similar complication rates, according to results of a retrospective study published in the August issue of Obstetrics and Gynecology.

The authors suggest that the use of barbed sutures may have contributed to the shorter operating time for traditional laparoscopic myomectomy.

Antonio R. Gargiulo, MD, from the Department of Obstetrics, Gynecology and Reproductive Biology and Channing Laboratory, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, and colleagues analyzed results of 115 consecutive laparoscopic removals of uterine fibroids and 174 consecutive robot-assisted laparoscopic myomectomies performed by 2 high-volume surgical teams among patient cohorts of similar age, body mass index, and leiomyoma characteristics during a period of 31 months.

Analysis revealed that robot-assisted laparoscopic myomectomy had an adjusted geometric mean operative time of 195.1 minutes (95% confidence interval [CI], 152 - 255 minutes) compared with the mean time for laparoscopic myomectomy of 118.3 minutes (95% CI, 87 - 170 minutes), for a change in adjusted geometric mean of 76.8 (P < .001).

The robotic surgery also led to a higher estimated blood loss of 110.0 mL compared with 85.9 mL in the group that received laparoscopic myomectomy (P < .04). The adjusted geometric mean for blood loss in the robotic laparoscopic procedure was 110.0 mL compared with 85.9 mL for laparoscopy. The analysis showed that postoperative complications were similar for the 2 groups.

The authors labeled the shorter operative time for the traditional laparoscopic myomectomy "significant in our view."

"Our data suggest that when these two techniques are performed by experienced teams, short-term clinical outcomes and complication rates are equivalent, but operative times are longer and estimated blood [losses] are larger for robot-assisted laparoscopic myomectomy," the authors write.

However, they suggest the use of barbed sutures may have contributed to the shorter operative times for traditional laparoscopy. Earlier studies have suggested that barbed sutures save significant time over conventional closures. In the current study, "barbed suture was used in 67.9% of the patients in the laparoscopic myomectomy group but in only 5.0% of the patients in the robot-assisted laparoscopic myomectomy group," the authors write. "Barbed sutures allow running closure in layers without the need for tying knots; this translates to a faster uterine closure time, which is reflected in decreased blood loss and decreased operative time, which are precisely the outcomes in which differences were noted in our study."

Other study results reflected the relative newness of the robot-assisted procedure, particularly the number of hospital admissions in the robot-assisted group.

Robot-assisted myomectomy patients were more likely to be admitted to the hospital (68 laparoscopic patients vs 129 robot-assisted patients; odds ratio [OR], 2.07; 95% CI, 1.14 - 3.74). These patients were also more likely to have a hospital stay of more than 1 day (4 laparoscopic patients vs 29 robot-assisted patients; OR 5.73; 95% CI, 1.58 - 20.81).

However, this was not a consequence of surgical outcomes. "When we introduced robot-assisted laparoscopic myomectomy at our hospital, we routinely admitted patients because we did not have any short-term or long-term perioperative complication outcome data," the authors write. As the study shows, however, complication rates for robot-assisted surgery proved comparable to standard laparoscopic surgery, which ultimately changed the practice of hospital admissions. "With these data, we now discharge patients on the same day of robot-assisted laparoscopic myomectomy or observe them for less than 24 hours when indicated."

The calculation for postoperative complications was adjusted for age, race, and largest leiomyoma removed. The analysis of operation length was adjusted for age and race. The estimated blood lose was adjusted for age, race, obesity, previous myomectomy, gravidity, largest uterine dimension, weight of leiomyomata, largest leiomyoma, and number of leiomyomata.

In the current study, patient populations were similar between the 2 cohorts in terms of age, body mass index, smoking status, and history of myomectomy, but there were racial differences between the participants: 70.3% of the robot-assisted group was white compared with 55.9% of the laparoscopic group. Tumor burden was similar in both groups.

The main study limitation was the retrospective design.

"We believe that our findings bear great clinical significance at a time when robotic surgery is set to penetrate our practices in ways and at a rate that are difficult to predict," the authors conclude.

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2012;120:284-291. Abstract

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