Robotic adnexal surgeries may have more complications than laparoscopic

1. The risk for intraoperative complications was significantly higher in patients undergoing robotic-assisted oophorectomy and cystectomies compared to those operated on laparoscopically.

2. Robotically-assisted oophorectomies and cystectomies were on average 51% and 80% more expensive than procedures performed laparoscopically.

Evidence Rating Level: 2 (Good)

Study Rundown: Adnexal surgeries such as oophorectomy and cystectomy have seen a fairly dramatic increase in procedures performed with the use of robotic assistance. Due to their relative lack of complexity, they have been considered a reasonable setting for surgeons to gain experience with the robotic platform. However, many studies aiming to demonstrate the improved effectiveness and safety of robotic-assisted procedures have been inconclusive. This study sought to characterize the current state of adnexal procedures performed with robotic assistance compared to laparoscopic methods, the current standard of care. The study found that patients undergoing oophorectomy or cystectomy with robotic assistance were at a significantly elevated risk for intraoperative complications when compared to laparoscopically performed surgeries. Additionally, the authors found that robotic assistance for both surgeries was associated with higher total costs. These findings are likely reflective of the novelty of robotic surgery. As the technology involved improves and surgeons gain experience with the robotic platform, it seems reasonable to expect both the cost and incidence of complications will decrease. Limitations include the inaccuracies related to ICD-9 code identification of procedures as well as variables such as the size and complexity of the lesion and past surgical history, which were not accounted for in the sensitivity analysis and could influence the treatment selection choice.

Click to read the study in Obstetrics and Gynecology

Relevant Reading: Comparison of Robotic-Assisted and Conventional Laparoscopy in the Management of Adnexal Masses

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In-Depth [retrospective study]: A national database was queried using ICD-9 codes and a total of 87,514 women at least 18 years of age who underwent oophorectomy (60.1%) or cystectomy (39.9%) between 2009 and 2012 were identified. Patients were then stratified based on whether the procedure was performed laparoscopically or with robotic assistance. Information related to patient demographics, perioperative morbidity, and acute complications (only up until the time of hospitalization) were collected for each patient. Propensity score-matched analysis was additionally performed. Propensity scores, which reflect the estimated likelihood a given patient would have the surgery performed, were calculated for each patient and patients in each group were subsequently matched by propensity score as part of the analysis. Patients undergoing robotically-assisted procedures had a higher risk of intraoperative complications when compared to the laparoscopic group for both oophorectomies (3.4% vs 2.1%; OR 1.60, 95% CI 1.21- 2.13) and cystectomies (2.0% vs 0.9%; OR 2.40, 95%CI 1.31-4.38). This elevated risk was due to significantly increase in complications related to bladder or ureteric injuries. Total costs of robotic-assisted oophorectomy was, on average, $2504 (51%) more expensive than procedures performed laparoscopically and the increase in cost was $3310 (80%) for cystectomy. Lastly, the study found that the percentage of oophorectomies performed with robotic assistance increased from 3.5% in 2009 to 15% in 2012, while a similar trend was seen in cystectomies with an increase of 2.4% to 12.9% across the same time span.

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