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Robot-assisted myomectomy versus open surgery: Cost-effectiveness analysis.

Alexandre Boyer De Latour1, Alexandra Vappereau2, Alicia Le Bras2

  • 1Assistance Publique-Hospitals of Paris, Department of Gynecological and Breast Surgery and Oncology, Pitié Salpêtrière Hospital, Paris, France.

Journal of Gynecology Obstetrics and Human Reproduction
|December 21, 2024
PubMed
Summary

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[How I do… a robot-assisted laparoscopic polymyomectomie with temporary uterine artery occlusion?]

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Robotic-assisted myomectomy (RAM) reduced hospital stays but was more expensive than open myomectomy (OM). While not increasing complications, RAM

Area of Science:

  • Gynecology
  • Surgical Oncology
  • Health Economics

Background:

  • Uterine fibroids are common benign tumors.
  • Surgical approach selection requires cost evaluation.
  • Robotic-assisted myomectomy (RAM) and open myomectomy (OM) are surgical options.

Purpose of the Study:

  • To compare the cost-effectiveness of RAM versus OM in France.
  • To evaluate major operative complications and costs associated with each procedure.
  • To determine the economic viability of RAM for large or multiple fibroids.

Main Methods:

  • Retrospective cost analysis and effectiveness comparison of RAM and OM.
  • Inclusion of women aged >18 with large (>8 cm) or multiple (3-5) fibroids.
  • Controlled confounding factors using inverse probability of treatment weighting.
Keywords:
ComplicationsCost-effectivenessGynecology surgeryMyomectomyRobot-assisted myomectomySurgery robotic

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  • Assessed costs and major complications (transfusions, blood loss ≥500 mL) one month post-surgery.
  • Calculated cost per major complication averted and incremental cost-effectiveness ratio (ICER).

    • Main Results:

    • RAM was associated with a non-significant reduction in major complications (36.19% vs. 38.48%).
    • RAM incurred an additional cost of €3,555 compared to OM (P < 0.01).
    • OM procedures were significantly shorter (157 min) than RAM (277 min) (P < 0.01).
    • RAM showed lower readmission rates (0% vs. 1.21%) and shorter length of stay (2.90 days vs. 4.34 days) (P < 0.01).

    Conclusions:

    • RAM reduces hospitalization length without increasing major intraoperative complications compared to OM.
    • The economic evaluation in the study setting did not favor RAM due to higher costs.
    • Further prospective studies with optimized RAM procedures are recommended to confirm findings.