Economic evaluation of robot-assisted, conventional laparoscopic, and open myomectomy: a 10-year single-center retrospective study
Robotic-assisted laparoscopy has expanded the surgical options for myomectomy, but its economic impact compared with laparotomy and conventional laparoscopy remains debated. We conducted a retrospective single-center study of 314 patients who underwent myomectomy between 2009 and 2019: 207 laparotomy, 78 robotic-assisted laparoscopy, and 29 conventional laparoscopy. Patients in the laparotomy group presented with significantly larger fibroids (mean weight 449 g vs 175 g in the robotic group, p < 0.001). Robotic procedures were associated with longer operative times (155 vs 98 min for laparotomy, p < 0.001) but shorter hospital stays (3.7 vs 5.0 days for laparotomy, p < 0.001). The hemoglobin drop was lower in the robotic group (1.2 vs 2.5 g/dL, p < 0.001), and minor complications were less frequent (8% vs 25% after laparotomy). Compared with conventional laparoscopy, robotic surgery allowed resection of more complex interstitial fibroids, but at the expense of longer operating times (155 vs 100 min for laparoscopy, p < 0.001). The mean global cost per procedure was €6,818 for robotic myomectomy, higher than laparotomy (€5,347) and laparoscopy (€5,188). Robotic myomectomy provides clinical advantages over laparotomy but remains associated with substantially higher costs.