Robot-Assisted Laparoscopic Myomectomy versus Abdominal Myomectomy for Large Myomas Sized over 10 cm or Weighing 250 g

Lee, Sa Ra; Lee, Eun Sil; Lee, Young Jae; Lee, Shin-Wha; Kim, Dae Yeon; Kim, Sung Hoon; Kim, Yong Man; Kim, Young Tak

doi:10.3349/ymj.2020.61.12.1054

Cited by 10 publications

(10 citation statements)

References 25 publications

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“…The initial pool of 955 studies, which resulted from the preliminary search of the medical databases, was refined via manual screening of the title and abstract, leading to 107 reports being moved to full-text assessment. Through constant evaluation and strict application of the pre-established inclusion criteria, 53 studies were ultimately included in this review [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ]. This systematic process of selection is summarised in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

Multi-Port Robotic-Assisted Laparoscopic Myomectomy: A Systematic Review and Meta-Analysis of Comparative Clinical and Fertility Outcomes

Tsakos¹,

Xydias

Ziogas

et al. 2023

JCM

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Background: Uterine fibroids are the most frequently diagnosed gynaecological tumours, and they often require surgical treatment (conventional laparoscopic myomectomy—CLM). The introduction and evolution of robotic-assisted laparoscopic myomectomy (RALM) in the early 2000s has expanded the range of minimally invasive options for the majority of cases. This study aims to compare RALM with CLM and abdominal myomectomy (AM). Methods and materials: Fifty-three eligible studies adhered to the pre-established inclusion criteria and were subsequently evaluated for risk of bias and statistical heterogeneity. Results: The available comparative studies were compared using surgical outcomes, namely blood loss, complication rate, transfusion rate, operation duration, conversion to laparotomy, and length of hospitalisation. RALM was significantly superior to AM in all assessed parameters other than operation duration. RALM and CLM performed similarly in most parameters; however, RALM was associated with reduced intra-operative bleeding in patients with small fibroids and had lower rates of conversion to laparotomy, proving RALM as a safer overall approach. Conclusion: The robotic approach for surgical treatment of uterine fibroids is a safe, effective, and viable approach, which is constantly being improved and may soon acquire widespread adoption and prove to be superior to CLM in certain patient subgroups.

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Section: Resultsmentioning

confidence: 99%

Multi-Port Robotic-Assisted Laparoscopic Myomectomy: A Systematic Review and Meta-Analysis of Comparative Clinical and Fertility Outcomes

Tsakos¹,

Xydias

Ziogas

et al. 2023

JCM

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“…The study reported that RM was associated with less EBL and a lower risk of blood transfusion than AM; however, no significant difference was found between RM and LM [34]. A recent study comparing RM (n = 126) and AM (n = 151) for large myomas (>10 cm or 250 g) observed no difference in EBL between the two groups [35]. A recent meta-analysis including a total of 2027 patients found no significant difference between RM and LM in terms of OT, EBL, blood transfusion, length of hospital stay, complications, and postoperative fertility [21].…”

Section: Previous Reports On Ebl and Total Ot In Rmmentioning

confidence: 94%

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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“…The use of RALM has several advantages which allows the articulation of instruments by 540° as well as easier intracorporeal suturing. It also may considered in complex surgical cases for which traditional laparoscopy is not indicated [66]. It should be clearly stated that RALM constitutes the minimally invasive alternative to open myomectomy in those cases that cannot be adequately and consistently addressed with conventional minimally invasive surgery [52].…”

Section: Open Vs Laparoscopic Myomectomymentioning

confidence: 99%

Fibroids and Infertility

Moreno¹,

López²

2021

Infertility and Assisted Reproduction

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Uterine fibroids (also known as leiomyomas or myomas) are the most common pelvic tumors, affecting more than 70% of women over 70 years of age and although most are asymptomatic, some women may experience symptoms, depending on their location and size, which can alter your quality of life, such as abnormal uterine bleeding, anemia, pelvic pain and pressure, dyspareunia, increased urinary frequency and constipation. Its relationship with infertility has been controversial and, although insignificant for subserous fibroids, it appears that submucosal and intramural fibroids that distort the endometrial cavity can affect embryo implantation and are associated with an increased risk of early pregnancy loss. Its treatment will depend on the patient’s symptoms, size, location, whether it is one or multiple, and whether or not she suffers from infertility. It is clear that submucosal fibroids have a negative impact on fertility and with respect to intramural fibroids it is known that fibroids larger than 4 cm alter the probability of pregnancy, however there are studies that show that even smaller or multiple fibroids could affect pregnancy rates. There are multiple options for the treatment of fibroids; however, patients who are candidates for expectant, medical or surgical management should be individualized, and especially if they are going to be taken to surgery, an excellent mapping of fibroids prior to surgical intervention is recommended. Minimally invasive surgery continues to be the approach of choice, it should be left for the open approach in cases in which Laparoscopy is contraindicated or the patient with multiple myomatosis.

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Robot-Assisted Laparoscopic Myomectomy versus Abdominal Myomectomy for Large Myomas Sized over 10 cm or Weighing 250 g

Cited by 10 publications

References 25 publications

Multi-Port Robotic-Assisted Laparoscopic Myomectomy: A Systematic Review and Meta-Analysis of Comparative Clinical and Fertility Outcomes

Multi-Port Robotic-Assisted Laparoscopic Myomectomy: A Systematic Review and Meta-Analysis of Comparative Clinical and Fertility Outcomes

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

Fibroids and Infertility

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