Comparison of robotic assisted laparoscopic myomectomy with barbed sutures and traditional laparoscopic myomectomy with barbed sutures

Chen, Yen-Cheng; Lin, Ho‐Hsiung; Hsiao, Sheng‐Mou

doi:10.1016/j.tjog.2018.08.017

Cited by 13 publications

(13 citation statements)

References 23 publications

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“…The duration of hospital stay in our study was signi cantly less for patients in the RM group as compared to the patients in the LM group (1.28 ± 0.49 vs. have reported a higher duration of hospital stay as compared to our study but the difference between the RM and LM group in these studies also was statistically signi cant [14][15][16][17][18][19][20][21]. A meta-analysis reported no statistical signi cance for the length of hospital stays between RM and LM group (OR 0.04, 95% CI, 0.09-0.18, p = .56) [22].…”

Section: Resultscontrasting

confidence: 58%

“…We consider this as an important nding as it contradicts the previously reported studies showing signi cantly higher operative time in Robotic myomectomies. An increase of surgical time (coe cient = 51.9 min, P < .001) was reported by Chen et al [15]. Wang et al reported a signi cantly prolonged operative time (weighted mean difference 84.88, p < .00001) in RM cases when compared to abdominal myomectomy cases [20].…”

Section: Resultsmentioning

confidence: 63%

“…In our study, the symptoms (dysmenorrhoea, heavy menstrual bleeding, abdominal mass, and frequency of urine) were signi cantly higher in the RM group as compared to the LM group (p = .006). A study by Chen YC et al, also reported higher symptoms (mass effect, bladder symptoms, dysmenorrhea, pelvic pain and abnormal uterine bleeding) in the RM group as compared to the LM group although the difference was not statically signi cant [24].…”

Section: Resultsmentioning

confidence: 91%

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Beyond the learning curve: improving outcomes in Robotic myomectomy compared to laparoscopic myomectomy

2022

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Uterine myomas are benign tumors frequently seen in women of reproductive age. Myomectomy remains a viable option for treating this condition in women who wish to preserve their uterus. We undertook this study to compare the peri-operative surgical outcomes of Robotic myomectomy (RM) with laparoscopic myomectomy (LM) in Indian patients of uterine myomas after the initial learning curve of RM was achieved. A retrospective chart review was performed for the patients who underwent RM or LM for the treatment of uterine myomas. A total of 177 patients; 116 in the RM group and 61 in the LM group were included in the study. The mean age in the RM and LM group was 34.31 ± 5.40 years and 33.54 ± 4.96 years respectively (p = .355). The mean total operative time was marginally more in RM group (127.37 ± 110.67 vs. 120.66 ± 44.27, p = .650) but the difference was not statistically signi cant. Patients in the RM group had signi cantly less blood loss (115.43 ± 79.43 vs. 340.98 ± 453.9 ml, p = <.0001), hospital stay (1.28 ± 0.49 vs. 1.92 ± 1.05 days, p = <.0001), requirement of blood transfusion (93.97% vs. 81.97%, p = .031) and requirement of intravenous (IV) analgesia (41.38% vs. 34.43%, p = .019) as compared to the patients in the LM group. The Robotic myomectomy signi cantly reduces blood loss, the duration of hospital stay, and requirement of blood transfusions and IV analgesia as compared to the laparoscopic myomectomy.

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Section: Resultscontrasting

confidence: 58%

Section: Resultsmentioning

confidence: 63%

Section: Resultsmentioning

confidence: 91%

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Beyond the learning curve: improving outcomes in Robotic myomectomy compared to laparoscopic myomectomy

2022

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“…In a meta-analysis design, the difference in blood loss between LM and RALM was only 42 mL, which was not statistically significant and is certainly not clinically significant [17]. Although articles comparing LM and RM did not report significant differences in EBL [17,36], RM can have limited advantages during the myoma retrieval and hemostasis procedures compared with LM [37], and we believe that this can affect the total OT and EBL. The limited availability of instruments for hemostasis during RM is one of the reasons.…”

Section: Our Opinion On the Innate Limited Advantages Of Rm Compared With Lm In Terms Of Eblmentioning

confidence: 81%

The Number of Myomas Is the Most Important Risk Factor for Blood Loss and Total Operation Time in Robotic Myomectomy: Analysis of 242 Cases

Lee

Kim

et al. 2021

JCM

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To identify factors affecting blood loss and operation time (OT) during robotic myomectomy (RM), we reviewed a total of 448 patients who underwent RM at Seoul Asan Hospital between 1 January 2019, and 28 February 2021, at Seoul Asan Hospital. To avoid variations in surgical proficiency, only 242 patients managed by two surgeons who each performed >80 RM procedures during the study period were included in this study. All cases of RM were performed with a reduced port technique. We obtained the following data from each patient’s medical chart: age, gravidity, parity, body mass index, and history of previous abdominal surgery including cesarean section. We also collected information on the maximal diameter and type of myomas, number and weight of removed myomas, concomitant surgery, total OT from skin incision to closure, estimated blood loss (EBL), and blood transfusion. Data on preoperative use of gonadotropin-releasing hormone agonists (GnRHas) and perioperative use of hemostatic agents (tranexamic acid or vasopressin) were also collected. Data on the length of hospital stay, postoperative fever within 48 h, and any complications related to RM were also obtained. The primary endpoint in this study was the identification of factors affecting EBL and the secondary endpoint was the identification of factors affecting the total OT during multiport RM. Univariate and multivariate analyses were used to identify the factors affecting EBL and OT during multiport RM. The medians of the maximal diameter and weight of the removed myomas were 9.00 (interquartile range [IQR], 7.00 to 10.00) cm and 249.75 (IQR, 142.88 to 401.00) g, respectively. The median number of myomas was two (IQR, one to four), ranging from 1 to 34. Of the cases, 155 had low EBL and 87 had high EBL. Most myomas were of the intramural type (n = 179). The odds of EBL > 320 mL increased by 251% (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.16–5.42) for five to nine myomas and by 647% (OR, 6.47; 95% CI, 1.87–22.33) for ≥10 myomas. The odds of subserosal-type myomas decreased by 67% compared with intramural-type myomas (OR, 0.33; 95% CI, 0.14–0.80). History of abdominal surgery other than cesarean section was positively correlated with EBL. The weight of the removed myomas and a history of previous cesarean section were not correlated with the EBL. Conclusion: The number of myomas (5–9 and ≥10), maximal myoma diameter, and history of abdominal surgery other than cesarean section affect the EBL in RM.

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“…Moreover, the therapeutic choice for patients with LBS-CC is debated [88]; therefore the patients enrolled in the current study were mainly based on shared decision making, which directly influenced the sample size, resulting in an insufficient power to properly compare PFS and OS between the two types of surgery after NACT. Second, based on the same reason shown above, an additional cost is required for receiving robotic surgery, which is not covered by the National Insurance Health Care System in Taiwan [89,90,91,92,93,94], and the risk of selection bias could not be totally avoided, contributing to a significantly greater number of patients with FIGO stage IIB in the robotic group. This is a well-known limitation of the retrospective design.…”

Section: Discussionmentioning

confidence: 99%

Radical Hysterectomy After Neoadjuvant Chemotherapy for Locally Bulky-Size Cervical Cancer: A Retrospective Comparative Analysis between the Robotic and Abdominal Approaches

Liu

Lee

Lin

et al. 2019

IJERPH

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Radical hysterectomy (RH) is the standard treatment for early stage cervical cancer, but the surgical approach for locally bulky-size cervical cancer (LBS-CC) is still unclear. We retrospectively compared the outcomes of women with LBS-CC treated with neoadjuvant chemotherapy (NACT) and subsequent RH between the robotic (R-RH) and abdominal approaches (A-RH). Between 2012 and 2014, 39 women with LBS-CC FIGO (International Federation of Gynecology and Obstetrics) stage IB2–IIB were treated with NACT-R-RH (n = 18) or NACT-A-RH (n = 21). Surgical parameters and prognosis were compared. Patient characteristics were not significantly different between the groups, but the NACT-R-RH group had significantly more patients with FIGO stage IIB disease, received multi-agent-based NACT, and had a lower percentage of deep stromal invasion than the NACT-A-RH group. After NACT-R-RH, surgical parameters were better, but survival outcomes, such as disease-free survival (DFS) and overall survival (OS), were significantly worse. On multivariate analysis, FIGO stage IIB contributed to worse DFS (p = 0.003) and worse OS (p = 0.012) in the NACT-A-RH group. Women with LBS-CC treated with NACT-R-RH have better perioperative outcomes but poorer survival outcomes compared with those treated with NACT-A-RH. Thus, patients with FIGO stage IIB LBS-CC disease might not be suitable for surgery after multi-agent-based NACT.

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Comparison of robotic assisted laparoscopic myomectomy with barbed sutures and traditional laparoscopic myomectomy with barbed sutures

Cited by 13 publications

References 23 publications

Beyond the learning curve: improving outcomes in Robotic myomectomy compared to laparoscopic myomectomy

Beyond the learning curve: improving outcomes in Robotic myomectomy compared to laparoscopic myomectomy

The Number of Myomas Is the Most Important Risk Factor for Blood Loss and Total Operation Time in Robotic Myomectomy: Analysis of 242 Cases

Radical Hysterectomy After Neoadjuvant Chemotherapy for Locally Bulky-Size Cervical Cancer: A Retrospective Comparative Analysis between the Robotic and Abdominal Approaches

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