Robotic myomectomy provided comparable perioperative results to laparoscopy in two retrospective studies of patients with symptomatic myomas (24,25). No significant differences were noted between both groups for blood loss, complications, and hospital stay. The robotic operating time was longer than laparoscopy in one of the studies and no different in the other (24,25). In our comparison study, we noted differences favorable to the robotic group relative to operating time (141 vs. 166 minutes), blood loss (100 vs. 250 mL), and hospital stay over 2 days (12% vs. 23%). There were no significant differences between groups when patients were adjusted for uterine size and myoma weight. There were no differences in intra-or postoperative complications. Postmyomectomy pregnancy rates, uterine rupture, and late operative complications using robotics remain undetermined.
Adnexectomy Numerous studies show the benefits of laparoscopy over laparotomy for patients with an adnexal mass. Robotics provides similar perioperative outcomes when compared to laparoscopy for patients with an adnexal mass. Outcomes were improved with robotics for obese patients (body mass index [BMI] ≥30) with an adnexal mass. In a comparison series of 176 patients with an adnexal mass, 85 operations were by robotics and 91 by laparoscopy (26). The operating time was 12 minutes longer for the entire robotic group (83 vs. 71 minutes), but it was similar to laparoscopy when comparing only patients with a BMI 30 or more (80 vs. 71 minutes). Blood loss was similar for both groups (39.1 vs. 41.2 mL), but lower for the robotic group when comparing only obese patients (BMI ≥30) (39 vs. 60 mL). The length of hospital stay, as measured by the number of patients staying longer than 2 days (0 vs. 3) was similar for both groups.
Tubal Reversal Robotic tubal reversal may be preferable to laparotomy. In a prospective study comparing both techniques on patients with a previous tubal ligation, the operating time was longer using robotics (201 vs. 155 minutes), but the hospital stay (4 hours vs. 1.3 days), and recovery time to normal activities (11.1 vs. 28.1 days) were improved for robotic patients (27). Both groups had similar pregnancy rates (62.5% vs. 50%). In another retrospective case-control study of outpatient tubal anastomosis performed by robotics or minilaparotomy, perioperative outcomes were similar except for a longer operating time, increased cost, and a shorter time to patient’s recovery with robotics (28).
Appendectomy Reported results on 107 robotic appendectomies performed in conjunction with other pelvic procedures had a mean time for appendectomy of 3.4 minutes. No perioperative complications related to appendectomy were encountered. Increased abnormal pathological findings were observed in patients with pelvic pain compared to those without pain (37% vs. 15%, respectively). Appendiceal metastases were found in 43% of patients with ovarian malignancy (29).
Sacrocolpopexy The robotic approach to sacrocolpopexy may be better than conventional laparoscopy because of the ease of suturing and of intracorporeal knot tying. A report of feasibility experience with 80 patients demonstrated total operating time of 197.9 minutes, and most patients underwent additional procedures at the same surgical setting (30). There was a 25.4% decrease of the operating time after the first 10 surgeries. Complications were minimal. Other reported operating times are 317 and 328 minutes (31,32).