Robotic Assisted Laparoscopic Tubal Anastomosis: Single Institution Analysis
Study Objectives: To study operative time and cost of robotic assisted laparoscopic tubal anastomosis beyond the learning curve. Secondary outcome measure was pregnancy and tubal patency rate.
Study Design: Retrospective Cohort Study
Setting: University-affiliated hospital
Patients: All patients who underwent robotic assisted laparoscopic tubal anastomosis from April 2013 to December 2018, performed by a single surgeon at a university-affiliated hospital.
Intervention: Robotic assisted laparoscopic tubal anastomosis surgery
Methods: 109 patients were identified who underwent robotic assisted laparoscopic tubal anastomosis. Retrospective analysis of patient demographics, operative time, pregnancy outcome and cost data were performed. Phone survey was conducted to elicit pregnancy rate.
Results: Operative times were evaluated for 106 consecutive cases and analyzed sequentially every year. Patient age ranged from 27 to 46 (median 36 ± 4.7), BMI ranged from 18 to 47 (median 29 ± 5.8). Previous ligations included excisional (63%), cautery (13%), and mechanical obstruction (24%). 60% of patients had previous laparotomy. 60% of patients underwent bilateral anastomosis based on tissue availability. Mean operative time decreased with experience. In 2013, the average operative time was 140.7 ± 27.0 min. Average operative time in 2018 was reduced to 60.0 ± 9.1 min. Downward trend in operative time was found to be highly significant (P < 0.001). The average total cost of the surgery was $7153.46 ± $1,484.41. The average direct cost of the procedure was $4,798.25.
Follow up information regarding pregnancy outcome was available in 59 patients. The mean time to follow up was 37.5 months. Thirty-five patients conceived spontaneously and 23 had not conceived during the follow up (59%). Tubal patency rate was 81% (42/52). When stratified based on age, 72% of patients under 37 became pregnant whereas the pregnancy rate was 44% and 45% in the age groups 37-39 and >40 years respectively.
Conclusions: There is significant improvement in operative time of robotic assisted tubal anastomosis over time. The operative time of robotic assisted tubal reversal in this series compares favorably and may even surpass those of the laparoscopy and laparotomy. Additionally, robotic assisted tubal anastomosis appears to be cost-effective compared to other approaches.
William Nolan, MD, Sisters of Charity Hospital, Buffalo, NY
William Nolan, MD, is currently a third year resident in Obstetrics and Gynecology at Sisters of Charity Hospital in Buffalo, New York, USA. Sisters Hospital is affiliated with the University at Buffalo. Dr. Nolan completed his undergraduate studies at the University at Buffalo with a degree in Biomedical Engineering, and continued to medical school at SUNY Upstate Medical University in Syracuse, NY. During medical school he completed an elective rotation with physicians working with fertility awareness based methods of family planning and a NaProTechnology trained surgeon. His professional interests include minimally invasive gynecologic surgery, NaproTechnology, infertility, and fertility awareness.
North American Regional Conference for Restorative Reproductive Medicine. July 22, 2020.