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.

[1]  J. Hulka,et al.  Reversibility of female sterilization. , 1985, Fertility and sterility.

[2]  M. Lawton,et al.  Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living , 1969 .

[3]  E. Katz,et al.  Tubal anastomosis: pregnancy success following reversal of Falope ring or monopolar cautery sterilization. , 1987, Fertility and sterility.

[4]  G. Ballantyne.  Robotic surgery, telerobotic surgery, telepresence, and telementoring , 2002, Surgical Endoscopy And Other Interventional Techniques.

[5]  M. Degueldre,et al.  Robotically assisted laparoscopic microsurgical tubal reanastomosis: a feasibility study. , 2000, Fertility and sterility.

[6]  Paul K. Wright,et al.  A quantification of dexterity , 1989 .

[7]  H. Peterson,et al.  Poststerilization regret: findings from the United States Collaborative Review of Sterilization. , 1999, Obstetrics and gynecology.

[8]  Tommaso Falcone,et al.  Laparoscopic microsurgical tubal anastomosis with and without robotic assistance. , 2003, Human reproduction.

[9]  T. Falcone,et al.  Robotics in gynecology. , 2003, The Surgical clinics of North America.

[10]  T. Falcone,et al.  Robotic-assisted laparoscopic microsurgical tubal anastomosis: a human pilot study. , 2000, Fertility and sterility.

[11]  Inderbir S. Gill,et al.  Robotics in Surgery , 2003 .

[12]  S. Silber,et al.  Microsurgical reversal of female sterilization: the role of tubal length. , 1980, Fertility and sterility.

[13]  G. Janik,et al.  Laparoscopic microsurgical tubal anastomosis. , 1999, Obstetrics and gynecology clinics of North America.

[14]  Warren D. Smith,et al.  Ergonomic problems associated with laparoscopic surgery , 1999, Surgical Endoscopy.

[15]  C. Librach,et al.  Microsurgical reversal of sterilization: a six-year study. , 1986, American journal of obstetrics and gynecology.

[16]  H. Reich,et al.  Laparoscopic tubal anastomosis. , 1993, The Journal of the American Association of Gynecologic Laparoscopists.

[17]  P. Devroey,et al.  Tubal surgery in the era of assisted reproductive technology: clinical options. , 1999, Human reproduction.

[18]  P. Madélénat,et al.  Tubal desterilization through exclusive laparoscopy. , 1989, Human reproduction.

[19]  B. Davies,et al.  Robotic surgery , 1993, IEEE Engineering in Medicine and Biology Magazine.

[20]  R. Winston.  REVERSAL OF TUBAL STERILIZATION , 1980, The Medical journal of Australia.

[21]  M S Rogers,et al.  A randomized prospective study of laparoscopy and laparotomy in the management of benign ovarian masses. , 1997, American journal of obstetrics and gynecology.

[22]  W. Divers.  Characteristics of women requesting reversal of sterilization. , 1984, Fertility and Sterility.

[23]  R. Satava.  Robotic surgery: from past to future--a personal journey. , 2003, The Surgical clinics of North America.

[24]  D. Rattner,et al.  Robotics and ergonomics. , 2003, The Surgical clinics of North America.