Reproductive Outcomes Following Robot-Assisted Laparoscopic Myomectomy: 10 Years' Experience

Introduction Robotic-assisted laparoscopic myomectomy (RALM) is being increasingly performed for large and multiple uterine myomas because of precise surgery and offers many short-term benefits over conventional surgeries; however, long-term effects in terms of reproductive outcome are not studied well. Our study aims at finding the pregnancy rate after RALM. We also studied secondary outcomes (rate of live births after RALM, conception technique (spontaneous or in-vitro fertilization (IVF)), and the correlation between pregnancy outcome and size, position, and number of fibroids removed. Methods and materials A single-center, retrospective observational study was conducted with patients who underwent RALM for fertility enhancement from August 2012 to May 2023 in the Department of Gynecology to know fertility outcomes. The RALM was performed using da Vinci Si and Xi. Results Out of 243 cases of RALM, 114 cases were operated for fertility enhancement (21 were lost to follow-up, and seven were not in the conception period). The outcome was analyzed for 86 patients (54 primary and 32 secondary infertility). The mean age was 31.99 ±4.53 years, and the mean fibroid weight was 347.83 ± 259.72 g. Forty-nine cases conceived spontaneously (six abortions) and 37 cases by IVF (12 failed, five abortions). The mean time to conception was 13.95 ± 4.82 months. All 63 cases were delivered by cesarean section (44 cases at 37-38 weeks, 17 cases at 36 weeks due to associated comorbidities, and two twin pregnancies delivered at 35 weeks). The pregnancy rate was 74/86 (86.04%) and the live births rate was 63/86 (73.25%). No statistical difference was found regarding the number of fibroids removed (p = 0.570) and size (p = 0.285) with pregnancy outcome. None of the myoma characteristics were related to abortion. Conclusion In our study, RALM was found to be an effective method for fertility enhancement.