Document Detail


Robotic compared with laparoscopic sacrocolpopexy: a randomized controlled trial.
MedLine Citation:
PMID:  24463657     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Laparoscopic and robotic sacrocolpopexy are widely used for pelvic organ prolapse (POP) treatment. Evidence comparing outcomes and costs is lacking. We compared costs and clinically relevant outcomes in women randomized to laparoscopic sacrocolpopexy compared with robotic sacrocolpopexy.
METHODS: Participants with symptomatic stage POP II or greater, including significant apical support loss, were randomized to either laparoscopic or robotic sacrocolpopexy. We compared surgical costs (including costs for robot, initial hospitalization) and rehospitalization within 6 weeks. Secondary outcomes included postoperative pain, POP quantification, symptom severity and quality of life, and adverse events.
RESULTS: We randomized 78 women (mean age 59 years): laparoscopic (n=38) and robotic (n=40). The robotic sacrocolpopexy group had higher initial hospital costs ($19,616 compared with $11,573, P<.001) and over 6 weeks, hospital costs remained higher for robotic sacrocolpopexy ($20,898 compared with $12,170, P<.001). When we excluded costs of robot purchase and maintenance, we did not detect a statistical difference in initial day of surgery costs of robotic compared with laparoscopic ($12,586 compared with $11,573; P=.160) or hospital costs over 6 weeks ($13,867 compared with $12,170; P=.060). The robotic group had longer operating room times (202.8 minutes compared with 178.4 minutes, P=.030) and higher pain scores 1 week after surgery (3.5±2.1 compared with 2.6±2.2; P=.044). There were no group differences in symptom bother by Pelvic Floor Distress Inventory, POP stage, or rate of adverse events.
CONCLUSION: Costs of robotic sacrocolpopexy are higher than laparoscopic, whereas short-term outcomes and complications are similar. Primary cost differences resulted from robot maintenance and purchase costs.
CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, www.clinicaltrials.gov, NCT01124916.
LEVEL OF EVIDENCE: I.
Authors:
Jennifer T Anger; Elizabeth R Mueller; Christopher Tarnay; Bridget Smith; Kevin Stroupe; Amy Rosenman; Linda Brubaker; Catherine Bresee; Kimberly Kenton
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  123     ISSN:  1873-233X     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2014 Jan 
Date Detail:
Created Date:  2014-01-27     Completed Date:  2014-03-18     Revised Date:  2014-07-31    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  5-12     Citation Subset:  AIM; IM    
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT01124916
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Female
Gynecologic Surgical Procedures* / economics,  statistics & numerical data
Humans
Laparoscopy* / economics,  statistics & numerical data
Middle Aged
Pelvic Organ Prolapse / surgery*
Robotics* / economics,  statistics & numerical data
Treatment Outcome
Grant Support
ID/Acronym/Agency:
RC1 EB010649/EB/NIBIB NIH HHS; RC1 EB010649-01/EB/NIBIB NIH HHS
Comments/Corrections
Comment In:
Obstet Gynecol. 2014 Jan;123(1):3-4   [PMID:  24463656 ]
Obstet Gynecol. 2014 Jun;123(6):1357-8   [PMID:  24848908 ]
Erratum In:
Obstet Gynecol. 2014 Jul;124(1):165

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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