Robotic-Assisted Laparoscopic vs Abdominal and Laparoscopic Myomectomy: Systematic Review and Meta-Analysis

Pundir, Jyotsna; Pundir, Vishal; Walavalkar, Rajalaxmi; Omanwa, Kireki; Lancaster, Gillian; Kayani, Salma

doi:10.1016/j.jmig.2012.12.010

Cited by 70 publications

(33 citation statements)

References 49 publications

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“…It is now established that laparoscopic myomectomy, whether through robot assistance or traditional laparoscopy, decreases perioperative morbidity as compared to myomectomy after laparotomy . Laparotomy is linked to increased adhesions, blood loss, and longer hospital stays . Thus laparoscopy should therefore be preferred whenever possible, as it also prevents postoperative adherences that can lead to further infertility .…”

Section: Discussionsupporting

confidence: 90%

Fertility and obstetrical outcomes after robot‐assisted laparoscopic myomectomy

Huberlant

Lenot

Neron

et al. 2019

Robotics Computer Surgery

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Objective: To evaluate fertility after robot-assisted laparoscopic myomectomy (RALM) in terms of pregnancy rates, and obstetrical outcomes.Patients: This is a retrospective cohort of RALM performed for symptomatic leiomyomas among women who want to conceive. Medical data were retrospectively reviewed. An office hysteroscopy was prescribed 3 months after the surgery.Results: Fifty-three patients were included. The mean number of myomas was 2 ± 1.5 with a mean size of 69 ± 17.7 mm. A breach of the cavity was noticed in 15.1% of the cases. Two cases of intrauterine adhesions were diagnosed and treated during the post-operative office hysteroscopy (5.7%).Clinical pregnancy rates were 52.8% with a live birth rate of 41.5% in patients desiring pregnancy. A caesarean section was performed in 17 cases (70.8%). No case of uterine rupture was reported.Conclusion: More than half of the patients became pregnant after RALM. A low rate of obstetrical complications was reported, with no uterine ruptures, highlighting the promise of this technique for infertile patients.infertility, miscarriage, myoma, robot-assisted myomectomy, synechiae imaging, strict and appropriate patient selection, and appropriate training in the safe practices of contained morcellation. 36 Although the number of subjects is higher than in some other studies, the present study is limited by its observational and retrospective nature. A randomized study, comparing standard laparoscopy vs robot-assisted myomectomy, would clarify the benefits of robot assistance on pregnancy rates, obstetrical complications, and intrauterine adherences more accurately (Table 7). | CONCLUSIONIn this retrospective series, we report 52.8% pregnancy rates after robot-assisted myomectomy in patients desiring pregnancy, and 47% pregnancy rates in infertile patients (half undergoing ART). In all, 78% of pregnancies gave way to a live birth, the majority through programmed caesarean sections. A low rate of obstetrical complications was reported, with no uterine ruptures, and no abnormal placentation. After systematic post-operative hysteroscopy in patients desiring pregnancy, a 5.7% intrauterine adhesion rate was found, a lower rate than those after laparoscopy or laparotomy published in the literature. This low synechiae rate probably contributes to fertility preservation.These results are encouraging for improving fertility after robotassisted myomectomy. A comparative, prospective, multicentre study, comparing standard laparoscopy vs robot-assisted laparoscopy in patients operated for myomectomy, with a longer follow-up, is highly encouraged.

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Section: Discussionsupporting

confidence: 90%

Fertility and obstetrical outcomes after robot‐assisted laparoscopic myomectomy

Huberlant

Lenot

Neron

et al. 2019

Robotics Computer Surgery

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“…This is a novel contribution to the literature regarding myomectomy and several authors have cited a need for this type of long-term outcome data [20, 21]. Many prior publications are case series from an individual surgeon at a single hospital reporting on relatively small numbers of patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Long-Term Fertility and Bleeding Outcomes after Robotic-Assisted, Laparoscopic, and Abdominal Myomectomy

Flyckt

Soto

Nutter

et al. 2016

Obstetrics and Gynecology International

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Background/Aims. To compare long-term fertility and bleeding outcomes of women who underwent robotic-assisted, laparoscopic, and abdominal myomectomy at our institution over a 15-year period. Methods. This was a retrospective cohort study of myomectomy patients 18–39 years old that had surgery between January 1995 and December 2009 at our institution. Long-term follow-up on fertility and bleeding outcomes was collected from the patient directly. The uterine fibroid symptom and quality of life survey was also administered to assess current bleeding patterns. Baseline characteristics were compared across groups. Univariable comparisons of fertility and bleeding outcomes based on surgical approach were made using analysis of variance, Kruskal-Wallis analysis of ranks, and Chi-square tests as appropriate. Results. 134/374 (36%) subjects agreed to participate in the study. 81 subjects underwent an open procedure versus 28 and 25 subjects in the laparoscopic and robotic groups, respectively. Median follow-up after surgery was 8 years. 50% of patients desired pregnancy following surgery and, of those, 60% achieved spontaneous pregnancy; the spontaneous pregnancy rate did not differ between groups. Additionally, UFS-QOL scores and/or subscores did not differ between groups. Conclusion. There is no significant difference in long-term bleeding or fertility outcomes in robotic-assisted, laparoscopic, or abdominal myomectomy.

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“…Different opinions are raised regarding the comparison of robotic procedures to laparoscopy, there are studies that claim that the reduced hospital stay after robotic surgery in comparison with laparoscopy may present a financial advantage over the standard laparoscopic procedures . Other studies showed closely similar advantages between these two minimally invasive techniques . At the moment, it seems that laparoscopy is a more economic minimally invasive method compared to robotic procedures.…”

Section: Discussionmentioning

confidence: 99%

Cost assessment of robotics in gynecologic surgery: A systematic review

Iavazzo

Papadopoulou

Gkegkes

2014

J of Obstet and Gynaecol

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Aim: The application of robotics is an innovation in the field of gynecologic surgery. Our objective was to evaluate the currently available literature on the cost assessment of robotic surgery of various operations in the field of gynecologic surgery. Material and Methods: PubMed and Scopus databases were systematically searched in order to retrieve the included studies in our review. Results Conclusion:Robotic surgery has the potential to become cost-effective in centers with many patients while industry competition could reduce the cost of the robotic instrumentation, making robotic technology more affordable and cost-effective.

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Robotic-Assisted Laparoscopic vs Abdominal and Laparoscopic Myomectomy: Systematic Review and Meta-Analysis

Cited by 70 publications

References 49 publications

Fertility and obstetrical outcomes after robot‐assisted laparoscopic myomectomy

Fertility and obstetrical outcomes after robot‐assisted laparoscopic myomectomy

Comparison of Long-Term Fertility and Bleeding Outcomes after Robotic-Assisted, Laparoscopic, and Abdominal Myomectomy

Cost assessment of robotics in gynecologic surgery: A systematic review

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