Moawad Gaby N, Abi Khalil Elias D, Tyan Paul, Shu Michael K, Samuel David, Amdur Richard, Scheib Stacey A, Marfori Cherie Q
Department of Obstetrics & Gynecology, George Washington University Hospital, 2150 Pennsylvania Avenue NW, Suite 6A429, 20037, Washington, DC, USA.
George Washington University School of Medicine, Washington, DC, USA.
J Robot Surg. 2017 Dec;11(4):433-439. doi: 10.1007/s11701-017-0674-4. Epub 2017 Jan 31.
Operative cost and outcomes between robotic and laparoscopic hysterectomy across different uterine weights. Retrospective cohort study including patients undergoing robotic and laparoscopic hysterectomy for benign disease at an Academic university hospital. One hundred and ninety six hysterectomies were identified (101 robotic versus 95 laparoscopic). Demographic and surgical characteristics were statistically equivalent. Robotic group had a higher body mass index (±SD) (32.9 ± 6.5 versus 30.4 ± 7.1, p 0.012) and more frequent history of adnexal surgery (12.9 versus 4.2%, p 0.031). Laparoscopic group had a higher number of concurrent salpingectomy (81 versus 66.3%, p 0.02). Estimated blood loss did not differ between procedures. Compared to robotic hysterectomies, laparoscopic procedures added 47 min (CI: 31-63 min; p < 0.001) of operative time, costed $1648 more (CI: 500-2797; p = 0. 005) and had triple the odds of having an overnight admission (OR = 2.94 CI: 1.34-6.44; p = 0.007). After stratification of cases by uterine weight, the mean operative time difference between the two groups in uteri between 750 and 1000 g and in uteri >1000 g was 81.3 min (CI: 51.3-111.3, p < 0.0001) and 70 min (CI: 26-114, p < 0.005), respectively, in favor of the robotic group. Mean direct cost difference in uteri between 750 and 1000 g and uteri >1000 g was 1859$ (CI: 629-3090, p < 0.006) and 4509$ (CI: 377-8641, p < 0.004), respectively, also in favor of the robotic group. In expert hands, robotic hysterectomy for uteri weighing more than 750 g may be associated with shorter operative time and improved cost profile.
不同子宫重量下机器人辅助与腹腔镜子宫切除术的手术成本及结局。一项回顾性队列研究，纳入在一所学术性大学医院接受机器人辅助和腹腔镜子宫切除术治疗良性疾病的患者。共识别出196例子宫切除术（101例机器人辅助手术，95例腹腔镜手术）。人口统计学和手术特征在统计学上具有可比性。机器人辅助手术组的体重指数（±标准差）更高（32.9±6.5 vs 30.4±7.1，p=0.012），附件手术史更常见（12.9% vs 4.2%，p=0.031）。腹腔镜手术组同时行输卵管切除术的比例更高（81% vs 66.3%，p=0.02）。两种手术方式的估计失血量无差异。与机器人辅助子宫切除术相比，腹腔镜手术的手术时间增加了47分钟（置信区间：31 - 63分钟；p<0.001），费用增加了1648美元（置信区间：500 - 2797美元；p=0.005），过夜住院的几率增加了两倍（比值比=2.94，置信区间：1.34 - 6.44；p=0.007）。按子宫重量对病例进行分层后，子宫重量在750至1000克之间以及子宫重量>1000克的两组患者中，机器人辅助手术组的平均手术时间差异分别为81.3分钟（置信区间：51.3 - 111.3，p<0.0001）和70分钟（置信区间：26 - 114，p<0.005），均有利于机器人辅助手术组。子宫重量在750至1000克之间以及子宫重量>1000克的两组患者的平均直接成本差异分别为1859美元（置信区间：629 - 3090美元，p<0.006）和4509美元（置信区间：377 - 8641美元，p<0.004），同样有利于机器人辅助手术组。在专家手中，对于子宫重量超过750克的患者，机器人辅助子宫切除术可能与更短的手术时间和更好的成本效益相关。
