Flexible Carbon Dioxide Laser Fiber Versus Ultrasonic Scalpel in Robot-Assisted Laparoscopic Myomectomy

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• 作者：Souzana Choussein ; MD^a ; Serene S. Srouji ; MD^a ; Leslie V. Farland ; MSc^a ; ^b ; Antonio R. Gargiulo ; MD^a ; ^{agargiulo@partners.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Carbon dioxide laser ; Laparoscopic myomectomy ; Robot-assisted myomectomy ; Ultrasonic scalpel
• 刊名：Journal of Minimally Invasive Gynecology
• 出版年：2015
• 出版时间：November-December 2015
• 年：2015
• 卷：22
• 期：7
• 页码：1183-1190
• 全文大小：704 K

文摘

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.