Robotic Compared With Laparoscopic Sacrocolpopexy: A Randomized Controlled Trial

Anger, Jennifer T. MD, MPH; Mueller, Elizabeth R. MD, MSME; Tarnay, Christopher MD; Smith, Bridget PhD; Stroupe, Kevin PhD; Rosenman, Amy MD; Brubaker, Linda MD, MS; Bresee, Catherine MS; Kenton, Kimberly MD, MS

doi: 10.1097/AOG.0000000000000006
Contents: Original Research
Correction

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

Despite similar short-term outcomes and complications, robotic sacrocolpopexy has higher costs than laparoscopic sacrocolpopexy as a result of robot maintenance and purchase costs.

Department of Surgery, Division of Urology, and the Biostatistics & Bioinformatics Research Center, Cedars-Sinai Medical Center, and the Department of Obstetrics/Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and the Departments of Obstetrics/Gynecology & Urology and Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, and the Center of Innovation in Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois.

Corresponding author: Jennifer T. Anger, MD, MPH, Associate Director of Urological Research, Cedars-Sinai Medical Center Department of Surgery, Adjunct Assistant Professor of Urology, UCLA, 99 N La Cienega Boulevard, #307, Beverly Hills, CA 90211; e-mail: angerj@cshs.org.

Funded by a National Institute of Biomedical Imaging and Bioengineering Recovery Act Limited Competition Challenge Grant (1 RC1 EB010649-01).

The authors thank Thea Rogers, MA, for her work with programming and analysis.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.