Robotic-assisted laparoscopic vs abdominal and laparoscopic myomectomy: systematic review and meta-analysis

Herein is presented a systematic review and meta-analysis of evidence related to operative outcomes associated with robotic-assisted laparoscopic myomectomy (RLM) compared with abdominal myomectomy (AM) and laparoscopic myomectomy (LM). Outcome measures included estimated blood loss (EBL), blood transfusion, operating time, complications, length of hospital stay (LOHS), and costs. Meta-analysis 1 compared RLM vs AM, and meta-analysis 2 compared RLM vs LM. Studies scored moderately well on the Newcastle-Ottawa Quality Assessment Scale. No significant differences were found in age, body mass index, or number, diameter, and weight of myomas. In meta-analysis 1, EBL, blood transfusion, and LOHS were significantly lower; risk of complications was similar; and operating time and costs were significantly higher with RLM. In meta-analysis 2, no significant differences were noted in EBL, operating time, complications, and LOHS with RLM; however, blood transfusion risk and costs were higher. It was concluded that insofar as operative outcomes, RLM has significant short-term benefits compared with AM and no benefits compared with LM. Long-term benefits such as recurrence, fertility, and obstetric outcomes remain uncertain.