Christopher Tarnay

Robotic Compared With Laparoscopic Sacrocolpopexy: A Randomized Controlled Trial

OBJECTIVE: Laparoscopic and robotic sacrocolpopexy are widely used for pelvic organ prolapse (POP) treatment. Evidence comparing outcomes and costs is lacking. We compared costs and clinically relevant outcomes in women randomized to laparoscopic sacrocolpopexy compared with robotic sacrocolpopexy. METHODS: Participants with symptomatic stage POP II or greater, including significant apical support loss, were randomized to either laparoscopic or robotic sacrocolpopexy. We compared surgical costs (including costs for robot, initial hospitalization) and rehospitalization within 6 weeks. Secondary outcomes included postoperative pain, POP quantification, symptom severity and quality of life, and adverse events. RESULTS: We randomized 78 women (mean age 59 years): laparoscopic (n=38) and robotic (n=40). The robotic sacrocolpopexy group had higher initial hospital costs (

Incision characteristics associated with six laparoscopic trocar-cannula systems: a randomized, observer-blinded comparison.

19,616 compared with

Entry force and intra-abdominal pressure associated with six laparoscopic trocar-cannula systems: a randomized comparison

11,573, P<.001) and over 6 weeks, hospital costs remained higher for robotic sacrocolpopexy (

Health literacy and disease understanding among aging women with pelvic floor disorders.

20,898 compared with

Patterns of pessary care and outcomes for medicare beneficiaries with pelvic organ prolapse.

12,170, P<.001). When we excluded costs of robot purchase and maintenance, we did not detect a statistical difference in initial day of surgery costs of robotic compared with laparoscopic (

Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies (ACCESS)☆

12,586 compared with

Video-based Peer Feedback Through Social Networking for Robotic Surgery Simulation: A Multicenter Randomized Controlled Trial

11,573; P=.160) or hospital costs over 6 weeks (

Intraabdominal Pressure and Incision Parameters Associated with a Pyramidal Laparoscopic Trocar-Cannula System and the EndoTIP Cannula

13,867 compared with

The impact of trocar-cannula design and simulated operative manipulation on incisional characteristics: a randomized trial.

12,170; P=.060). The robotic group had longer operating room times (202.8 minutes compared with 178.4 minutes, P=.030) and higher pain scores 1 week after surgery (3.5±2.1 compared with 2.6±2.2; P=.044). There were no group differences in symptom bother by Pelvic Floor Distress Inventory, POP stage, or rate of adverse events. CONCLUSION: Costs of robotic sacrocolpopexy are higher than laparoscopic, whereas short-term outcomes and complications are similar. Primary cost differences resulted from robot maintenance and purchase costs. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, www.clinicaltrials.gov, NCT01124916. LEVEL OF EVIDENCE: I

Randomized Comparison of the Effect of Manipulation on Incisional Parameters Associated with a Pyramidal Laparoscopic Trocar-Cannula System and the EndoTIP Cannula

OBJECTIVE Laparoscopic trocar-cannula systems of different design but similar internal diameter result in incisions of varying dimensions. Such variations might affect the incidence of incisional complications, such as dehiscence and hernia. We developed a system to measure associated fascial defects and then used the techniques to compare the defects resulting from different trocar-cannula systems. METHODS This was a randomized, observer-blinded study. Six laparoscopic trocar-cannula systems of similar diameter (12 mm) were tested (two pyramidal, two blunt conical, and two cutting-dilating) using a white swine model. All systems were inserted into each of 12 subjects, with location designated by random allotment (total 72 insertions). The fascial defects were exposed and then directly measured for incisional length and area by an observer blinded to the system used. Means of each outcome variable (incisional length and area) were compared using factorial analysis of variance. RESULTS The values for mean incisional areas were as follows: cutting-dilating 28.73 mm2 and 31.09 mm2, pyramidal 18.25 mm2 and 26.75 mm2, and blunt conical 10.00 mm2 and 12.33 mm2. Mean maximal incisional lengths were similar among all trocar-cannula systems. CONCLUSION Blunt conical trocar-cannula systems resulted in significantly smaller fascial defects compared with the widely used pyramidal and the two cutting-dilating trocar-cannula systems tested. These differences have potential clinical implications. For example, smaller fascial defects could reduce risk of incisional hernia and dehiscence.