The effects and costs of laparoscopic versus abdominal myomectomy in patients with uterine fibroids: a systematic review and meta-analysis

Abstract

Background: Abdominal myomectomy (AM) and laparoscopic myomectomy (LM) are commonly see surgery for the uterine fibroids, several randomized controlled trials (RCTs) have compared the role of AM and LM, the results remained inconsistent. Therefore, we attempted this meta-analysis to analyze the role of LM versus AM in patients with uterine fibroids. Methods: We searched PubMed et al. databases from inception date to July 31, 2019 for RCTs that compared LM versus AM in patients with uterine fibroids. Two authors independently screened the studies and extracted data from the published articles. Summary odd ratios(OR) or mean differences(MD) with 95% confidence intervals(CI) were calculated for each outcome by means of fixed-or random-effects model. Results: Twelve RCTs with a total of 1783 patients were identified, with 887 patients for and 897 patients for AM. Compared with AM, LM could significantly decrease the blood loss (OR = − 29.78, 95% CI-57.62-− 0.95), shorten the duration of postoperative ileus (OR = − 10.91, 95% CI-18.72-− 3.11), reduce the length of hospital stay (OR = − 1.57, 95% CI-2.05-− 1.08), but LM was associated with longer duration of operation (OR = 16.10, 95% CI 6.52-25.67) and higher medical cost (OR = 17.61, 95% CI 7.34-27.88). Conclusions: LM seems to be a better choice for patients with uterine fibroids, more related studies are needed to identify the role of LM and AM for the treatment of uterine fibroids.

Fibroid Removal after Myomectomy: An Overview on the Problems of Power Morcellation

“…Chen et al [ 33 ] conducted a meta-analysis that included twelve randomized clinical trials with a total of 1783 patients, to compare postoperative outcomes and complications in laparoscopic vs. open myomectomy. They observed a significant decrease in the blood loss, duration of postoperative ileus, and length of hospital stay after laparoscopic myomectomy.…”

Complications in laparoscopic and robotic-assisted surgery: definitions, classifications, incidence and risk factors - an up-to-date review.

“…Since its beginnings in the 1970s, laparoscopy has gradually become the standard surgical approach to the abdominal cavity in all surgical specialties including gynecology [ 1 ]. The benefits of modern laparoscopy are: decreased blood loss, less postoperative pain, fewer wound complications, reduced risk of adhesion formation, shorter hospital stay, faster return to daily activities, excellent cosmetic results [ 2 – 5 ], and lower treatment costs in comparison to open abdominal procedures [ 3 – 5 ]. The implementation of robotic-assisted laparoscopic surgery (RALS) – following the USA Food and Drug Administration approval for the first DaVinci system in 2005 – allowed for further minimizing intraoperative blood loss and acceleration of patient recovery [ 6 – 8 ].…”

Perioperative Myomectomy Outcomes Based on the Current Coding Rules

“…Although there have been several reported investigations evaluating perioperative outcomes after myomectomy, [9][10][11] we wanted to specifically understand if perioperative outcomes on a national level were significantly different depending on surgical approach regardless of leiomyoma burden. We identified one article by Jansen et al that examined perioperative outcomes for 659 myomectomies based on surgical approach stratified by severe myoma burden, with severe myoma burden defined as the upper quartile of specimen weight 434.6 g or more or seven or more myoma count.…”