Histerektomide robotik veya laparoskopik yaklaşım: operatif sonuçlar ve maliyet karşılaştırılması

Amaç: Bu çalışma, robotik yardımlı cerrahi (RAC) ve geleneksel laparoskopik cerrahi (GLC) histerektomi prosedürlerinin cerrahi sonuçlarını ve maliyet analizini karşılaştırmayı amaçlamaktadır. Gereç ve Yöntem: Uterin fibroid, anormal uterin kanama, endometrial hiperplazi, adenomiyozis, persiste eden over kistleri, kronik pelvik ağrı gibi benign jinekolojik bozukluklar nedeniyle bilateral salpingo-ooferektomi ile birlikte veya salpingo-ooferektomi olmaksızın total robotik histerektomi veya total konvansiyonel laparoskopik histerektomi uygulanan hastalar geriye dönük olarak değerlendirildi. Bulgular: Çalışma dönemi sırasında toplam 80 kadına RAC veya GLC histerektomi yapıldı. Ortalama toplam ameliyat süresi RAC ve GLC gruplarında sırasıyla 187 ± 10 dk. ve 133 ± 24 dk. idi . RAC histerektomi grubunun ortalama toplam maliyeti 17.710 TL ve GLC histerektomi grubunun 7000 TL idi. Sonuç: İyi huylu jinekolojik endikasyonlar için hem GLC hem de RAC histerektomiler ihmal edilebilir komplikasyon oranları ile güvenli cerrahi prosedürlerdir. Maliyetlerle ilgili olarak, RAC, GLC 'ye göre daha pahalı bir prosedürdür.

Robotic or laparoscopic approach for hysterectomy: comparison of operative outcomes and cost

Purpose: The present study aimed to compare surgical outcomes and cost analysis of robotic-assisted surgery (RAS) and conventional laparoscopic surgery (CLS) hysterectomy procedures. Materials and Methods: The patients who underwent total robotic hysterectomy or total conventional laparoscopic hysterectomy with or without bilateral salpingo-oophorectomy due to benign gynecological disorders such as uterine fibroid, abnormal uterine bleeding, endometrial hyperplasia, adenomyosis, persistent ovarian cysts, chronic pelvic pain were retrospectively evaluated. Results: A total of 80 women underwent RAS or CLS hysterectomy during the study period. The mean total operative time was 187 ±10 min. in RAS and 133 ±24 min. in CLS groups, respectively. The mean total cost of the RAS hysterectomy group was 17.710 TL, and CLS hysterectomy group was 7000 TL. Conclusion: Both CLS and RAS hysterectomies for benign gynecological indications are safe surgical procedures with negligible complication rates. RAS is a more expensive procedure compared to CLS.

Keywords:

hysterectomy, gynecology, robot-enhanced surgery,

PDF

___

[1] Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy rates in the United States, 2003. Obstet Gynecol 2007; 110:1091–5.
[2] Liao G, Zhao Z, Lin S, Li R, Yuan Y, Du S, et al. Robotic-assisted versus laparoscopic colorectal surgery: a meta-analysis of four randomized controlled trials. World J Surg Oncol 2014; 12: 122.
[3] Tekkis PP, Senagore AJ, Delaney CP, Fazio VW. Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 2005; 242: 83-91.
[4] Franasiak J KE, Kidd J, Secord AA, Bell M, Boggess JF, Gehrig PA. Physical strain and urgent need for ergonomic training among gynecologic oncologists who perform minimally invasive surgery. Gynecol Oncol 2012;126(3): 437-42.
[5] Paley PJ VD, Shah CA, Everett EN, Bondurant AE, Drescher CW, Peters WA 3rd. Surgical outcomes in gynecologic oncology in the era of robotics: analysis of first 1000 cases. Am J Obstet Gynecol 2011;204(6):551.e1-9.
[6] Barbash GI, Glied SA New technology and health care costs: the case of robot-assisted surgery. N Engl J Med 2010; 363:701–4.
[7] Tapper AM, Hannola M, Zeitlin R, Isojärvi J, Sintonen H, Ikonen TS. A systematic review and cost analysis of robot-assisted hysterectomy in malignant and benign conditions. Eur J Obstet Gynecol Reprod Biol 2014; 177:1–10.
[8] Martino MA, Berger EA, McFetridge JT, Schubella J, Gosciniac G, Wejksznr T, et al A comparison of quality outcome measures in patients having a hysterectomy for benign disease: robotic vs non-robotic approaches. J Minim Invasive Gynecol 2014; 21:389–93.
[9] Gala RB, Margulies R, Steinberg A, Murphy M, Lukban J, Jeppson P, et al. Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy. J Minim Invasive Gynecol 2014;21:353–61.
[10] Liu H, Lawrie TA, Lu D, Song H, Wang L, Shi G. Robot-assisted surgery in gynaecology. Cochrane Database Syst Rev 2014;12: CD011422.
[11] Albright BB, Witte T, Tofte AN, Chou J, Black JD, Desai VB, Erekson EA. Robotic Versus Laparoscopic Hysterectomy for Benign Disease: A Systematic Review and Meta-Analysis of Randomized Trials. J Minim Invasive Gynecol 2016;23(1):18-27.
[12] O’Neill M, Moran PS, Teljeur C, O'Sullivan OE, O'Reilly BA, Hewitt M, et al. Robot-assisted hysterectomy compared to open and laparoscopic approaches: systematic review and meta-analysis. Arch Gynecol Obstet 2013;287:907–18.
[13] Martınez-Maestre MA, Gambadauro P, Gonzalez-Cejudo C, Torrejon R. Total laparoscopic hysterectomy with and without robotic assistance: a prospective controlled study. Surg Innov 2014;21: 250–5.
[14] Ngan TYT, Zakhari A, Czuzoj-Shulman N, Tulandi T, Abenhaim HA. Laparoscopic and Robotic-Assisted Hysterectomy for Uterine Leiomyomas: A Comparison of Complications and Costs. J Obstet Gynaecol Can 2018;40(4):432-9.
[15] Barbash GI, Glied SA. New technology and health care costs: the case of robot-assisted surgery. N Engl J Med 2010;363:701–4.
[16] Pasic RP, Rizzo JA, Fang H, Ross S, Moore M, Gunnarsson C. Comparing robot-assisted with conventional laparoscopic hysterectomy: impact on cost and clinical outcomes. J Minim Invasive Gynecol 2010;17:730-8.
[17] Sarlos D, Kots L, Stevanovic N, Schaer G. Robotic hysterectomy versus conventional laparoscopic hysterectomy: outcome and cost analyses of a matched case-control study. Eur J Obstet Gynecol Reprod Biol 2010;150:92-6.
[18] The SAGES-MIRA Robotic Surgery Consensus Group. A consensus document on robotic surgery. 2007. Available at: http://www.sages.org/ publications/guidelines/consensus-document-robotic-surgery/. Accessed on April 28, 2016.