Non-hysteroscopic Myomectomy and Fertility Outcomes: A Systematic Review.

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.

/pdf/multi-port-robotic-assisted-laparoscopic-myomectomy-a-2znhxsta.pdf

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

Comparison of operative and fertility outcomes of single-incision robotic myomectomy: a retrospective single-center analysis of 286 cases.

Multi-port robotic assisted (Da Vinci) laparoscopic myomectomy: a systematic review and meta-analysis of comparative clinical and fertility outcomes.Elias Tsakos1,2, Emmanouil M. Xydias1,2,3, Apostolos C. Ziogas2,3, Felice Sorrentino4, Luigi Nappia4, Nikolaos Vlachos5, Aggelos Daniilidis61: EmbryoClinic IVF, Thessaloniki, Greece2: Hellenic medical Research Institute (HMRI), Thessaloniki, Greece3: University of Thessaly, School of Health Sciences, Faculty of Medicine, Larissa, Greece4: Institute of Obstetrics and Gynecology, University of Foggia, Italy5: National and Kapodistrial University of Athens, School of Medicine, Department of Obstetrics and Gynaecology6: Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, GreeceAbstract 

/pdf/multi-port-robotic-assisted-da-vinci-laparoscopic-myomectomy-c59wh8in.pdf

Multi-port robotic assisted (Da Vinci) laparoscopic myomectomy: a systematic review and meta-analysis of comparative clinical and fertility outcomes. 

BACKGROUND
Myomectomy is the preferred treatment for women with uterine fibroids and fertility requirements. There are three modalities are used in clinical practice for myomectomy: abdominal myomectomy (AM), laparoscopic myomectomy (LM), and robot-assisted laparoscopic myomectomy (RLM).


OBJECTIVES
To compare the perioperative and postoperative outcomes of RLM, AM, and LM.


SEARCH STRATEGY
We searched PubMed, Web of Science, Embase, and Clinical Trials for relevant literature published between January 2000 and January 2023.


SELECTION CRITERIA
We included all studies reporting peri- and postoperative outcomes of myomectomy in patients with uterine myomas. Surgical treatments were classified as RLM, LM, or AM.


DATA COLLECTION AND ANALYSIS
Two or more authors selected studies independently, assessed risk of bias, and extracted data. We derived mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CIs) for each outcome, subgrouping trials by the patient characteristics and myoma characteristics. We used the I2 statistic to quantify heterogeneity and the random-effects model for meta-analysis when appropriate. We used the funnel plot to assess the publication bias.


MAIN RESULTS
A total of 32 studies with 6357 patients were included, of which 1982 women had undergone RLM. The operating time was significantly longer (MD = 43.58, 95% confidence interval [CI]: 25.22-61.93, P < 0.001), and the incidence of cesarean section after myomectomy was significantly lower (OR = 0.27, 95% CI: 0.10-0.78, P = 0.02) in RLM than in LM. Compared with AM, the operation time, blood loss, blood transfusion rate, complication rate, total cost, length of hospital stay, and pregnancy rate of patients with RLM were significantly different.


CONCLUSIONS
The safety and effectiveness of RLM are superior to those of AM but inferior to those of LM.

Robotic-assisted laparoscopic versus abdominal and laparoscopic myomectomy: A systematic review and meta-analysis.

To compare surgical outcomes of patients with leiomyomas after robotic-assisted laparoscopic myomectomy (RALM), laparoscopic myomectomy (LsM), or laparotomic myomectomy (LtM) and to construct a useful algorithm for the best modus operandi for uterine leiomyomas. Design: A retrospective chart review. Data included patient (age and BMI) and fibroid characteristics (number, measurements of the primary fibroid, type, and location), operating time, blood loss, hospitalization length, complications during and after surgery, and complications during posttreatment pregnancies. Comparisons were based on chi-square and two-sample t tests. Setting: University teaching hospital. Patients: Between 1 January 2009 and 31 December 2016, 51 RALMs, 84 LsMs, and 52 LtMs were performed at our institution. Interventions: Three different approaches of myomectomy were performed: robotic-assisted laparoscopy (RALM), laparoscopy (LsM), and laparotomy (LtM). There was no significant difference in the distribution of the location and the type of myoma between the three groups. The mean size of the largest myoma removed by LsM, RALM, and LtM was 60.9, 70.8, and 92.6 mm (p < 0.05), respectively. Surgical outcomes between the three modalities were comparable except for increased mean blood loss and postoperative bleeding and longer hospital stay for patients with LtM and for longer operation time when performing RALM. RALM should replace open surgery if feasible and should not replace traditional laparoscopy unless other benefits are proven.

/pdf/implementing-robotic-assisted-myomectomy-in-surgical-2mbil025j3.pdf

Implementing robotic assisted myomectomy in surgical practice – a retrospective cohort study

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Implementing robotic assisted myomectomy in surgical practice – a retrospective cohort study