Robotic-assisted vs. laparoscopic and abdominal myomectomy for treatment of uterine fibroids: a meta-analysis

Abstract

Uterine fibroids are extremely common uterine neoplasms. However, whether robotic-assisted laparoscopic myomectomy (RALM) is superior to laparoscopic myomectomy (LM) or abdominal myomectomy (AM) is still debatable. Consequently, we aimed to compare the three currently major surgical techniques used in patients with uterine fibroids. We searched the PubMed, the Cochrane Library, MEDLINE, Embase, and Web of Science databases up to April 22, 2017. The meta-analysis included 20 studies involving 2852 patients. The number of complications [odd ratio (OR) 0.52, p = 0.009], estimated blood loss (EBL) [weighted mean difference (WMD) -33.03, p = 0.02], conversions (OR 0.34, p = 0.03), and postoperative bleeding (OR 0.18, p = 0.03) in RALM cases was significantly less than that for LM. The numbers of complications (OR 0.56, p = 0.03), length of hospital stay (WMD -1.74, p < 0.00001), EBL (WMD -77.74, p < 0.00001), and numbers of transfusions (OR 0.25, p < 0.0001) were significantly decreased, and the operative time (WMD 84.88, p < 0.00001) was significantly prolonged in RALM cases when compared to AM cases. Compared with LM and AM, RALM is associated with significantly fewer complications, significantly lower EBL, significantly fewer conversions than both LM and AM, and significantly less bleeding than LM.

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

“…LM mainly uses the observation hole and the operation hole to understand the anatomical structure and the lesion, and completes the lesions removal under the guidance of the TV screen [38]. While the AM requires a long incision in the abdomen for direct vision, the trauma and the pulling force of related tissue during the AM are relatively large [39], hence the risk of complications is higher and the recovery is slower. It can be seen that the LM in patients with uterine fibroids has obvious advantages, which can promote the rapid recovery after surgery and enhance the safety of patients.…”

Comparison of surgical outcomes between robotic &amp; laparoscopic single-site myomectomies

“…Additionally, in the present study, EBL was higher in the RSSM group (210.1±162.2 vs. 161.4±158.7 mL, P=0.013) than in the LSSM group. It has been known that wristed instrumentation and the three-dimensional vision system in robotic systems make suturing more accurate and faster [16]. These advantages may lead to decreased blood loss during operation.…”

“…These advantages may lead to decreased blood loss during operation. In fact, a meta-analysis [16] including 2,852 patients reported that EBL (weighted mean difference, -33.03; P=0.02) in robotic multi-site myomectomy was significantly less than that for laparoscopic myomectomy. On the other hand, our result was different.…”

Laparoscopic versus Abdominal Myomectomy: Surgical and Post-Operative Outcomes in CHRACERH-Yaounde

“…This contradicts results obtained by Kalogiannidis et al in 2010 [11] who reported the average blood loss for LM 246 ± 161 ml and 351 ± 219 ml for laparotomy group (p = 0.03) which was statistically significant. Also Wang et al [12] in 2018 in a meta-analysis: robotic-assisted vs. laparoscopic and abdominal myomectomy for treatment of uterine fibroids concluded that there was a significant less amount of blood in robotic assisted laparoscopic myomectomy compared to laparotomy myomectomy. The mean operation time (H) (mean ± SD) was 1.27 ± 0.13 for LM group which was significantly less than 2.05 ± 0.07 for AM group (p = 0.006) ( Table 3).…”

“…Contrarily, Nicel et al in 2014 [7] reported longer operation time with laparoscopic myomectomy which was 148.33 ± 66.26 min compare with 102.75 ± 42.37 min which was statistically significant (p = 0.013) laparotomy myomectomy. Wang et al [12] in 2018 in a meta-analysis concluded that robotic assisted laparoscopic myomectomy had prolonged operation time compared to laparotomy myomectomy. In our study, the difference could be explained by the fact that much time was spent suturing the regions from which the fibroids were extracted and the abdominal wall in AM group and also surgeon dependent.…”