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Robotic compared with laparoscopic sacrocolpopexy: a randomized controlled trial.

Jennifer T Anger1, Elizabeth R Mueller, Christopher Tarnay

  • 1Department 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.

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Robotic sacrocolpopexy is more expensive than laparoscopic surgery for pelvic organ prolapse (POP), with similar short-term outcomes and complication rates. The higher costs are primarily due to robot purchase and maintenance fees.

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Area of Science:

  • Urogynecology
  • Minimally Invasive Surgery
  • Pelvic Organ Prolapse Treatment

Background:

  • Laparoscopic and robotic sacrocolpopexy are common treatments for pelvic organ prolapse (POP).
  • Comparative data on outcomes and costs between these surgical approaches is limited.
  • This study addresses the evidence gap by comparing clinical outcomes and costs.

Purpose of the Study:

  • To compare the costs and clinically relevant outcomes of laparoscopic sacrocolpopexy versus robotic sacrocolpopexy.
  • To evaluate surgical costs, including initial hospitalization and rehospitalization within 6 weeks.
  • To assess secondary outcomes such as postoperative pain, POP quantification, symptom severity, quality of life, and adverse events.

Main Methods:

  • Randomized controlled trial involving 78 women with symptomatic stage II or greater POP.
  • Participants were randomized to either laparoscopic sacrocolpopexy or robotic sacrocolpopexy.
  • Surgical costs, operating room times, postoperative pain, POP quantification, symptom severity, quality of life, and adverse events were compared between groups.

Main Results:

  • Robotic sacrocolpopexy incurred higher initial hospital costs ($19,616 vs. $11,573) and 6-week costs ($20,898 vs. $12,170).
  • Excluding robot purchase/maintenance costs, initial and 6-week costs were not statistically different between groups.
  • The robotic group experienced longer operating room times (202.8 vs. 178.4 minutes) and higher 1-week postoperative pain scores (3.5 vs. 2.6).
  • No significant differences were observed in symptom bother, POP stage, or adverse event rates between the two surgical methods.

Conclusions:

  • Robotic sacrocolpopexy is associated with higher overall costs compared to laparoscopic sacrocolpopexy.
  • Short-term clinical outcomes and complication rates are comparable between the two procedures.
  • The primary drivers of cost disparity are the initial purchase and ongoing maintenance expenses of the robotic system.