Robotic-Assisted, Laparoscopic, and Abdominal Myomectomy: A Comparison of Surgical Outcomes

OBJECTIVE: To compare the surgical outcomes of robot-assisted laparoscopic myomectomy (robot-assisted), standard laparoscopic myomectomy (laparoscopic), and open myomectomy (abdominal). METHODS: Myomectomy patients were identified from the case records of the Cleveland Clinic and stratified into three groups. Operative and immediate postoperative outcomes were compared. Data analysis was performed using analysis of variance, Kruskal-Wallis analysis of ranks, &khgr;2, and Fisher exact tests where appropriate. RESULTS: From a total of 575 myomectomies, 393 (68.3%) were abdominal, 93 (16.2%) were laparoscopic, and 89 (15.5%) were robot-assisted. The three groups were comparable regarding the size, number, and location. Significantly heavier myomas were removed in the robot-assisted group (223 [85.25, 391.50] g) compared with the laparoscopic group (96.65 [49.50, 227.25] g, P<.001) and were lower than in the abdominal group (263 [ 90.50, 449.00] g, P=.002). Higher blood loss was reported in the abdominal group compared with the other two groups, with a median (interquartile range) of blood loss in milliliters of 100 (50, 212.50), 200 (100, 437.50) and 150 (100, 200) in the laparoscopic, abdominal, and robot-assisted groups, respectively. The actual surgical time in minutes was 126 (95, 177) in the abdominal group, 155 (98, 200) in the laparoscopic group, and 181 (151, 265) in robot-assisted group (P<.001). Patients in the abdominal group had a higher median length of hospital stay of 3 (2, 3) days, compared with 1 (0, 1) day in the laparoscopic group and 1 (1, 1) days in the robot-assisted group (P<.001). CONCLUSION: Robotic-assisted myomectomy is associated with decreased blood loss and length of hospital stay compared with traditional laparoscopy and to open myomectomy. Robotic technology could improve the utilization of the laparoscopic approach for the surgical management of symptomatic myomas. LEVEL OF EVIDENCE: II

[1]  E. Mascha,et al.  Case-control study of laparoscopic versus abdominal myomectomy. , 2000, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[2]  Christina Gloeckner,et al.  Modern Applied Statistics With S , 2003 .

[3]  Arnold P Advincula,et al.  Robot-assisted laparoscopic myomectomy versus abdominal myomectomy: a comparison of short-term surgical outcomes and immediate costs. , 2007, Journal of minimally invasive gynecology.

[4]  S. Oehninger,et al.  Uncomplicated full term pregnancy after da Vinci-assisted laparoscopic myomectomy. , 2007, Reproductive biomedicine online.

[5]  R Kevin Reynolds,et al.  Preliminary experience with robot-assisted laparoscopic myomectomy. , 2004, The Journal of the American Association of Gynecologic Laparoscopists.

[6]  B. Noble,et al.  Comparison of robotic and laparoscopic myomectomy. , 2009, American journal of obstetrics and gynecology.

[7]  Matthew T Gettman,et al.  Robotic-assisted laparoscopic sacrocolpopexy for treatment of vaginal vault prolapse. , 2004, Urology.

[8]  C. Chapron,et al.  Pregnancy outcome and deliveries following laparoscopic myomectomy. , 2000, Human reproduction.

[9]  Tommaso Falcone,et al.  Minimally invasive management of uterine fibroids , 2002, Current opinion in obstetrics & gynecology.

[10]  H. Reich,et al.  Fertility after laparoscopic myomectomy of large uterine myomas: operative technique and preliminary results. , 2003, European journal of gynaecological oncology.

[11]  S. Guerriero,et al.  Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome. , 1996, American journal of obstetrics and gynecology.

[12]  J. Manson,et al.  Variation in the Incidence of Uterine Leiomyoma Among Premenopausal Women by Age and Race , 1997, Obstetrics and gynecology.

[13]  Cheng-Chang Chang,et al.  Laparoscopy-assisted robotic myomectomy using the da Vinci system. , 2007, Taiwanese journal of obstetrics & gynecology.

[14]  Ofra Barnett,et al.  Robotic Assisted Laparoscopic Myomectomy Compared with Standard Laparoscopic Myomectomy – A Retrospective Matched Control Study , 2008 .

[15]  T. Falcone,et al.  Robotic-assisted laparoscopic microsurgical tubal anastomosis: a human pilot study. , 2000, Fertility and sterility.

[16]  C. Flamigni,et al.  Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. , 2000, Human reproduction.

[17]  L. Pereira,et al.  Pregnancy outcomes following treatment for fibroids: uterine fibroid embolization versus laparoscopic myomectomy , 2006, Current opinion in obstetrics & gynecology.

[18]  K. Semm.  New Methods of Pelviscopy (Gynecologic Laparoscopy) for Myomectomy, Ovariectomy, Tubectomy and Adnectomy , 1979, Endoscopy.

[19]  A. García-Ruiz,et al.  Full robotic assistance for laparoscopic tubal anastomosis: a case report. , 1999, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[20]  T. Falcone,et al.  Robotics in gynecology. , 2003, The Surgical clinics of North America.

[21]  G. Wegienka,et al.  Analysis of the impact of body mass index on the surgical outcomes after robot-assisted laparoscopic myomectomy. , 2009, Journal of minimally invasive gynecology.

[22]  B. Hurst,et al.  Laparoscopic myomectomy for symptomatic uterine myomas. , 2005, Fertility and sterility.

[23]  T. Tulandi,et al.  Treatment of uterine fibroids for abnormal uterine bleeding: myomectomy and uterine artery embolization. , 2007, Best practice & research. Clinical obstetrics & gynaecology.