Efficacy and safety of robot-assisted laparoscopic myomectomy versus laparoscopic myomectomy: a systematic evaluation and meta-analysis

Abstract

Objective: Systematic evaluation of the efficacy and safetyof robotic-assisted laparoscopic myomectomy (RALM)versus laparoscopic myomectomy (LM). Methods: PubMed, Embase, The Cochrane Library and Web of Science database were searched by computer to seek relevant literatures in order to compare the efficacy and safety of RALM with that of LM from the establishment of the databases to January 2023, and Review Manager5.4 software was utilized to perform a meta-analysis of the literatures. Results: A total of 15 retrospective clinical controlled studies were included. There exists a total of 45702 patients, among 11618 patients in the RALM group and the remaining 34084 patients in the LM group. Meta-analysis results revealed that RALM was associated with less intraoperative bleeding(MD=－32.03, 95%CI －57.24 to －6.83, P=0.01), lower incidence of blood transfusions(OR=0.86, 95%CI 0.77 to 0.97, P=0.01), shorter postoperative hospital stay(MD=－0.11, 95%CI －0.21 to －0.01, P=0.03), fewer transitions to open stomach(OR=0.82, 95%CI 0.73 to 0.92, P=0.0006) and lower incidence of post-operative complications(OR=0.58, 95%CI 0.40 to 0.86, P=0.006) than LM; whereas, LM is more advantageous in terms of operating time(MD=38.61, 95%CI 19.36 to 57.86, P<0.0001); no statistically significant difference between the two surgical approaches in terms of maximum myoma diameter(MD=0.26, 95%CI －0.17 to 0.70, P=0.24). Conclusion In the aspects of intraoperative bleeding, lower incidence of blood transfusions, postoperative hospital stay, transit open stomach rate and post-operative complications, RALM has unique advantage than that of LM; while LM has advantages over RALM in terms of operating time.