Robotic Transabdominal Cerclage vs Laparotomy: A Comparison of Obstetric and Surgical Outcomes |
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| Affiliation: | 1. Department of Obstetrics and Gynecology (Dr. Brink);2. Division of Minimally Invasive Gynecologic Surgery (Drs. Smith and Mourad);3. Division of Maternal-Fetal Medicine (Dr. Perlow);4. Department of Internal Medicine (Dr. Gerkin), University of Arizona College of Medicine, Phoenix, Arizona;5. Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Dr. Hu);1. Department of Gynecological Surgery, Vita Batel Hospital (Drs. Vigueras Smith, Cabrera, Zomer, Kondo, and Talledo);2. Department of Gynecological Surgery, Minimal Invasive Surgery and Oncology Unit in Erasto Gardner Hospital (Dr. Ribeiro), Curitiba, Brazil. |
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| Abstract: | Study ObjectiveTo compare obstetric and surgical outcomes of transabdominal cerclage (TAC) via laparotomy (TAC-LAP) versus robotic-assisted (TAC-RA) approaches.DesignRetrospective cohort study.SettingAn academic medical center.PatientsSixty-nine women with acquired or congenital cervical insufficiency.InterventionsAll women underwent TAC either by laparotomy or robotic-assisted approaches by 2 primary surgeons between January 2003 and July 2018. Women with a preconceptional TAC without a subsequent pregnancy were excluded.Measurements and Main ResultsA total of 69 women met inclusion criteria in the 15-year study period with 40 in the historical TAC-LAP group and 29 in the TAC-RA group. Gestational age at delivery was similar in the 2 groups (36 weeks 3 days vs 37 weeks; median difference −1 day, 95% confidence interval [CI] −6 to 2, p = .36). There were no differences in birth weight, Apgar scores, neonatal intensive care unit admission, or neonatal survival. Estimated blood loss and length of stay were significantly greater in the TAC-LAP group (50 mL vs 20 mL; median difference 25, 95% CI 5–40, p = .007 and 76 hours vs 3 hours; median difference 71, 95% CI 65–75, p <.001, respectively). Operative time was significantly shorter in the TAC-LAP group (65 minutes vs 132 minutes; median difference −64.7, 95% CI −79 to −49, p <.001). There was one intra-operative complication and 4 minor postoperative complications in the TAC-LAP group and none observed in the TAC-RA group. All outcomes were similar when comparing postconceptional TAC alone, except there was no longer a difference in blood loss. When comparing pre- versus postconceptional robotic TAC, there were no differences in surgical outcomes.ConclusionRobotic TAC has similar favorable obstetric outcomes to traditional laparotomy and is associated with reduced blood loss and shorter hospital stays. Despite longer operative times, the robotic group did not experience any intra-operative or postoperative complications, which speaks to the benefits of this minimally invasive approach to TAC. |
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