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 safety of 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 literature 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 Manager 5.4 software was utilized to perform a meta-analysis on the literature. Results A total of 15 retrospective clinical controlled studies were included. There exists a total of 45,702 patients, among 11,618 patients in the RALM group and the remaining 34,084 patients in the LM group. Meta-analysis results revealed that RALM was associated with lesser 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 postoperative complications (OR = 0.58, 95%CI 0.40 to 0.86, P = 0.006) than LM, whereas LM is more advantageous in terms of operative time (MD = 38.61, 95%CI 19.36 to 57.86, P < 0.0001). There was no statistical difference between the two surgical methods 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 postoperative complications, RALM has a unique advantage than that of LM, while LM has advantages over RALM in terms of operative time.

Currently Available Treatment Modalities for Uterine Fibroids

“…It allows for a three-dimensional stereoscopic view, greater dexterity with seven degrees of freedom in each of the jointed instruments and the mitigation of hand tremors, which can facilitate fibroid dissection and multilayer suturing. As such, the robotically assisted approach is safe and effective and therefore should be considered in more technically challenging cases, such as those with particularly large bulky fibroids, tumors involving the cervix and lower uterine segment or extending into the pelvic sidewall or extensive pelvic adhesive disease [ 89 , 90 ].…”

“…Overall, robotically assisted myomectomy confers similar patient care benefits in comparison to laparoscopic myomectomy. The common disadvantage of robotic surgery is the financial cost, including higher hospital/professional charges and hospital reimbursement rates [ 87 , 89 ].…”

C-section technique vs minilaparotomy after minimally invasive uterine surgery: a retrospective cohort study

“…It can be performed through different surgical approaches, including laparotomy, laparoscopy/robotic-assisted surgery, or hysteroscopy. The choice of surgical approach primarily depends on the location of the fibroids, their number and their size [ 18 ]. When conditions allow, it is clearly preferable to opt for a minimally invasive technique.…”

Comparison of Surgical Outcomes of Two New Techniques Complementing Robotic Single-Site Myomectomy: Coaxial Robotic Single-Site Myomectomy vs. Hybrid Robotic Single-Site Myomectomy

“…The use of the da Vinci robot system (Intuitive Surgical., Inc., Sunnyvale, CA, USA) has become widespread in myomectomy, particularly given its advantages such as a three-dimensional surgical view, reduced surgeon's tremor, and improved suturing capabilities. Similarly to laparoscopic myomectomy, robot-assisted laparoscopic myomectomy presents several benefits over myomectomy performed through laparotomy, such as reduced blood loss, shorter hospital stays, and fewer surgical complications [12,13]. Single-site robotic surgery offers better cosmetic results compared with multi-port robotic surgery, as it necessitates only one intra-umbilical skin incision [11,14].…”