Robotic tubal anastomosis: surgical technique and cost effectiveness

Objective

To evaluate the feasibility of robotic microsurgical tubal anastomosis and compare the results and cost effectiveness with the same procedure performed by laparotomy.

Design

Prospective cohort study.

Setting

University hospital.

Patient(s)

Patients with a history of bilateral tubal ligation who desired reversal for future fertility.

Intervention(s)

Tubal anastomoses through either a robotic approach or through a laparotomy.

Main Outcome Measure(s)

Operative times, hospitalization, complications, postoperative patency, clinical outcomes, and the cost per live birth.

Result(s)

The mean operative time for robotic anastomoses was statistically significantly greater than open anastomoses (ROBOT 201 minutes; OPEN 155.3 minutes), although hospitalization times were statistically significantly shorter (ROBOT 4 hours; OPEN 34.7 hours). The return to instrumental activities of daily living was accelerated in the patients who had undergone a robotic anastomosis (ROBOT 11.1 days; OPEN 28.1 days). Although this was a small series, the pregnancy rates were comparable between groups (ROBOT 62.5%; OPEN 50%), yet the rate of abnormal pregnancy was higher in the robotic group (ectopic: ROBOT 4, OPEN 1; spontaneous pregnancy loss: ROBOT 2, OPEN 1). The cost per delivery was similar between the groups (ROBOT $92,488.00, OPEN $92,205.90).

Conclusion(s)

Robotically assisted laparoscopic microsurgical tubal anastomosis is feasible and cost effective with results that are comparable with the traditional open approach.

Key Words: Tubal anastomosis, robotic-assisted surgery, tubal surgery, cost-effectiveness