Surgical approach to uterine myomatosis in patients with infertility: open, laparoscopic, and robotic surgery; results according to the quantity of fibroids

Abstract

Objective To compare approaches to myomectomy (laparotomic, laparoscopic, and robotic). To show the relationship between the number of fibroids and the reproduction diagnosis. Methods Observational, analytical, retrospective, and cross-sectional study; where the surgical approach used, was evaluated in terms of surgical bleeding, time, number and weight of fibroids and reproductive results. Results 69 patients were treated through different approaches and divided into 3 groups. The differences found among groups were in favor of laparotomic myomectomy in terms of the number ( p =0.000) and weight of fibroids ( p =0.004). Robotic surgery was also longer ( p =0.000). In the analysis of the influence of the number of fibroids to achieve pregnancy, the result was in favor of the minimally invasive routes, after surgery, both in the group of < 6 fibroids ( p =0.017), and that of > 6 fibroids ( p =0.001), without differences in the time from surgery to pregnancy ( p =0.979). Conclusions The surgical approach decision should consider the number and size of resected fibroids, surgical time, and reproductive diagnosis. The minimally invasive route should be offered whenever possible due to its better outcome on achieving pregnancy, without forgetting the benefits of laparotomy, while also accrediting the recently introduced robotic-assisted approach.

Efficacy and safety of robot-assisted laparoscopic myomectomy versus laparoscopic myomectomy: a systematic evaluation and meta-analysis

“…A total of 1219 articles were obtained, and after eliminating duplicates by Endnote X9, and then eliminating irrelevant papers by reading the title and abstract, 15 articles were retained after reading the full text [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. See Table 1 for basic information on the selected literature.…”

“…The results [MD=-24.67, 95%CI (-41.91, -7.43), P=0.005] indicate a statistically signi cant difference between the two surgical approaches in terms of intraoperative bleeding, suggesting that the RALM group had less intraoperative bleeding than the LM group, the results of the Meta-analysis are shown in Figure3. P=0.01] indicate a statistically signi cant difference in the incidence of blood transfusions between the two procedures, suggesting that fewer people in the RALM group required blood transfusions than in the LM group, the results of the Meta-analysis are shown in Figure4.Comparison of transit open belly ratesA total of 11 studies were included [8-17,22] with a total of 45,092 patients, 11,347 patients in the RALM group and 33,745 patients in the LM group.Statistical heterogeneity between studies was not signi cant (P=0.32>0.1, I 2 =13%), so a xed effects model was used for data analysis. The results [OR=0.82, 95%CI (0.73, 0.92), P=0.0006] indicate a statistically signi cant difference between the two surgical approaches in terms of intermediate openings, suggesting a lower rate of intermediate openings in the RALM group than in the LM group, the results of the Meta-analysis are shown in Figure6.…”

“…15,[17][18][19][20][21][22] with a total of 1937 patients, 941 patients in the RALM group and 996 patients in the LM group.There was statistical heterogeneity between studies (P<0.00001, I 2 =94%), so a random effects model was used for data analysis. The results [MD=38.61, 95%CI (19.36, 57.86), P<0.0001] indicate a statistically signi cant difference between the two surgical approaches in terms of operative time, suggesting that the LM group had a shorter operative time than the RALM group, the results of the Meta-analysis are shown in Figure2.Comparison of intraoperative bleedingA total of 11 studies [8-10,12-15,17-18,[21][22] were included with a total of 1367 patients, 648 patients in the RALM group and 719 patients in the LM group.Comparison of length of stay in hospitalA total of 10 studies were included[9][10][12][13][14][15]17,[20][21][22] with a total of 1425 patients, 669 patients in the RALM group and 756 patients in the LM group. There was statistical heterogeneity between studies (P=0.54, I 2 =0%), so a xed effects model was used for data analysis.…”

Surgical and Fertility Outcomes of Reduced-Port Robotic Myomectomy: A Single-Center Experience of 401 Cases

“…The reported pregnancy rates in the current literature range from 29.1% to 77.8% with no uterine rupture [ 12 , 13 , 14 , 16 , 17 , 18 , 19 ]. Pitter et al reported a pregnancy rate of 50.8% with a follow-up of 36 months, and the uterine rupture rate in this study was 0.9% [ 15 ].…”

“…The rates were comparable among the three groups [ 16 ]. A more recent study by Morales et al also investigated three methods and found similar clinical pregnancy rates: 29.1% in RALM, 29.1% in laparoscopic myomectomy, and 14.3% in open myomectomy [ 19 ].…”