Single-Incision versus Multiport Robotic Myomectomy: A Propensity Score Matched Analysis of Surgical Outcomes and Surgical Tips

Abstract

We aimed to compare the perioperative outcomes of single-incision robotic myomectomy (SIRM) and multiport robotic myomectomy (MPRM) and provide surgical tips. We retrospectively analyzed the medical records of 462 patients with symptomatic leiomyoma who underwent MPRM or SIRM between March 2019 and April 2021. Demographic characteristics and surgical outcomes, including the total operative time (OT), estimated blood loss (EBL), and surgical complication rate, were compared between the two groups. Patients in the SIRM group had lower a body mass index and rate of previous pelvic surgery and were younger than those in the MPRM group. The myoma type was not different between groups; however, the MPRM group had larger, and more myomas than the SIRM group. After propensity score matching, these variables were not significantly different between the groups. The total OT, EBL, difference in hemoglobin levels, transfusion rate, and postoperative fever were not different between the groups. No postoperative complications occurred in the SIRM group. In the MPRM group, one patient needed conversion to laparotomy, and two patients had postoperative complications (umbilical incisional hernia and acute kidney injury). In conclusion, both MPRM and SIRM are feasible and effective surgical options for symptomatic myomas with cosmetic benefits and minimal risk of laparotomy conversion.

Robotic Single-Site Plus Two-Port Myomectomy versus Conventional Robotic Multi-Port Myomectomy: A Propensity Score Matching Analysis

“…To the best of our knowledge, this is the first cohort study to have evaluated surgical outcomes of RSTM versus those of CRM. Although there have been two studies on RSTM [ 8 , 9 ], there is none that has weighed the pros and cons of RSTM against CRM’s.…”

“…For CRM, four incision sites, including the 12-mm camera port at the umbilicus, two 8-mm side ports, and a 12-mm or 5-mm laparoscopic assistant port, are required. Robotic single-site myomectomy (RSSM) has been introduced to minimize surgical injury by reducing the number of ports; however, many studies have reported problematic issues due to inherent technical problems, such as limited traction with semi-rigid instruments, as well as range-of-motion limitations [ 7 , 8 ].…”

Initial experience of single-incision plus one port totally laparoscopic pancreaticoduodenectomy

“…Single-incision laparoscopic surgery is an important branch of laparoscopic technology that has been performed in almost every eld of surgery such as general surgery, gynecology, urology, and thoracic 4,5 . SILS offers potential bene ts over conventional laparoscopic surgery, including a reduced risk of trocar-related complications, reduced postoperative pain, and improved convalescence and cosmetic results [16][17][18] .…”

“…However, combining a challenging resection and multiple anastomoses is still a technical di culty. Single-incision laparoscopic surgery (SILS) has been widely used in gynecological and thoracic surgery with many bene ts including a reduced risk of trocar-related complications, reduced postoperative pain, and improved convalescence and cosmetic results 4,5 .…”

Current status on robotic assisted myomectomy

“…The authors suggested preferring abdominal or laparoscopic approach in cases with extreme myoma weight and abdominal in cases of large number of myomas. On the other hand, Kim et al [31] compared 30 robotic vs. 13 open surgeries for the removal of ≥ 10 myomas. Operating times were longer in the robotic approach (360 min vs. 180 min), while length of hospital stay was shorter (2.5 days vs. 3.5 days).…”