Mini-laparotomy (MINI) Versus Robotic-Assisted (ROBA) Myomectomy: Comparing Costs and Safety [ID 1067]

INTRODUCTION: Uterine fibroids, associated with pelvic pain, abnormal bleeding, and infertility, occur in over 50% of women. Although both are minimally invasive procedures, robotic procedures have been emphasized over MINI in training programs. Prior studies favor ROBA from a safety aspect; however, few studies have compared this to same-day mini-laparotomy myomectomies. This study sought to determine the safety and costs of MINI versus ROBA. METHODS: Patients who underwent MINI (n=98) at an outpatient surgery center were compared to 89 patients who underwent ROBA myomectomies. All patients had a same-day discharge. We compared mean estimated blood loss, mean operative times, and rate of complications (transfusions, organ injury, readmission). We extrapolated costs using existing literature and local information. Cost estimates included preoperative care, operating room (OR), recovery room, physician, and supply costs. RESULTS: MINI was associated with decreased operative time (97.5 minutes versus 181 minutes with ROBA), decreased time to discharge (210 minutes versus 481 minutes), fewer complications (one transfusion required for MINI, two transfusions for ROBA), and lower associated costs ($4,937 for MINI versus $7,299 with ROBA). There was a nonsignificant increase in estimated blood loss with MINI compared to ROBA. CONCLUSIONS/IMPLICATIONS: MINI myomectomies are a cost-effective, safe alternative to ROBA myomectomies. Using standard OR equipment and traditional surgical skills, MINI had shorter OR times and times to discharge at significantly reduced costs. With the large shift toward ROBA surgeries in recent years, this study determined that MINI remains a safe, cost-effective option for our patients.