Robotic tubal anastomosis: surgical technique and cost effectiveness

Objective: To evaluate the feasibility of robotic microsurgical tubal anastomosis and compare the results and cost effectiveness with the same procedure performed by laparotomy. Design: Prospective cohort study. Setting: University hospital. Patient(s): Patients with a history of bilateral tubal ligation who desired reversal for future fertility. Intervention(s): Tuba anastomoses through either a robotic approach or through a laparotomy. Main Outcome Measure(s): Operative times, hospitalization, complications, postoperative patency, clinical outcomes, and the cost per live birth. Result(s): The mean operative time for robotic anastomoses was statistically significantly greater than open anastomoses, (ROBOT 201 minutes; OPEN 155.3 minutes), although hospitalization times were statistically significantly shorter (ROBOT 4 hours; OPEN 34.7 hours). The return to instrumental activities of daily living was accelerated in the patients who had undergone a robotic anastomosis (ROBOT 11.1 days; OPEN 28.1 days). Although this was a small series, the pregnancy rates were comparable between groups (ROBOT 62.5%; OPEN 50%), yet the rate of abnormal pregnancy was higher in the robotic group (ectopic: ROBOT 4, OPEN 1; spontaneous pregnancy loss: ROBOT 2, OPEN 1). The cost per delivery was similar between the groups (ROBOT $92,488.00, OPEN $92,205.90). Conclusion(s): Robotically assisted laparoscopic microsurgical tubal anastomosis is feasible and cost effective with results that are comparable with the traditional open approach.