Flexible carbon dioxide laser fiber versus ultrasonic scalpel in robot-assisted laparoscopic myomectomy

Study Objective: To compare the effectiveness and safety of a flexible carbon dioxide (CO₂) laser fiber to the ultrasonic scalpel when employed through a robotic surgical system. Design: Retrospective cohort study. Design Classification: Level II-2 evidence. Setting: Reproductive surgery practice at an academic hospital. Patients: Two hundred thirty-six women who had undergone robot-assisted laparoscopic myomectomy with either CO₂ laser (n = 85) or the ultrasonic scalpel (n = 151). Interventions: Robot-assisted laparoscopic myomectomy employing either a flexible CO₂ laser fiber or a robotic ultrasonic scalpel as the primary energy tool. Measurements and Main Results: Perioperative outcomes (estimated blood loss, operative time, length of hospital stay) of patients undergoing robot-assisted myomectomy with a flexible laser fiber or ultrasonic scalpel. Estimated blood loss and operative time were comparable (p = .95 and p = .55, respectively) between the 2 groups after adjusting for all confounders, whereas length of hospital stay remained significantly different (p = .004). Odds ratio for complications was 0.35 (95% confidence interval 0.08-1.56; p = .17), which denotes no difference in the risk for complications between the 2 groups. Conclusion: Robot-assisted laparoscopic myomectomy with a flexible CO₂ laser fiber is safe and has comparable operative outcomes to the ultrasonic scalpel. The small size and flexibility of this device allows robotic surgeons to employ safe focal energy without sacrificing operative ergonomics.