TY - JOUR
T1 - Robotic Transabdominal Cerclage vs Laparotomy
T2 - A Comparison of Obstetric and Surgical Outcomes
AU - Smith, Rachael B.
AU - Brink, Janel
AU - Hu, Chengcheng
AU - Gerkin, Richard
AU - Perlow, Jordan H.
AU - Mourad, Jamal
N1 - Funding Information:
The authors wish to acknowledge the expert contributions of William H. Clewell, MD, who provided comprehensive maternal-fetal medicine care for women with cervical insufficiency and performed each of the laparotomy TAC procedures reported in this article. We also thank Nichole Mahnert, MD, for her contribution to the manuscript and our Clinical Research Nurse Coordinator, Regina Montero, MSN RN CNOR.
Publisher Copyright:
© 2019 AAGL
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Study Objective: To compare obstetric and surgical outcomes of transabdominal cerclage (TAC) via laparotomy (TAC-LAP) versus robotic-assisted (TAC-RA) approaches. Design: Retrospective cohort study. Setting: An academic medical center. Patients: Sixty-nine women with acquired or congenital cervical insufficiency. Interventions: All 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 Results: A 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. Conclusion: Robotic 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.
AB - Study Objective: To compare obstetric and surgical outcomes of transabdominal cerclage (TAC) via laparotomy (TAC-LAP) versus robotic-assisted (TAC-RA) approaches. Design: Retrospective cohort study. Setting: An academic medical center. Patients: Sixty-nine women with acquired or congenital cervical insufficiency. Interventions: All 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 Results: A 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. Conclusion: Robotic 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.
KW - Cervical insufficiency
KW - Cervicoisthmic cerclage
KW - Robotic-assisted cerclage
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U2 - 10.1016/j.jmig.2019.08.014
DO - 10.1016/j.jmig.2019.08.014
M3 - Article
C2 - 31421250
AN - SCOPUS:85072752440
SN - 1553-4650
VL - 27
SP - 1095
EP - 1102
JO - Journal of Minimally Invasive Gynecology
JF - Journal of Minimally Invasive Gynecology
IS - 5
ER -