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Surgical and Postoperative Outcomes in Laparoscopic vs Robotic Myomectomy: A Systematic Review and Meta-Analysis
Gabriella Ferreira Marucci da Silva1, Lorena Burim Bernardo da Silva1, Maria Luísa de Andrade Reis1
1Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil (all authors).
Objective:
To compare surgical and postoperative outcomes associated with robotic and laparoscopic myomectomy in women with symptomatic uterine leiomyomas and to inform clinical decision-making.
Data Sources:
From October to November 2025, a comprehensive search was conducted in PubMed, EMBASE, and Scopus with no date restrictions. The search strategy included the following terms: "Leiomyoma" OR "Uterus myoma" OR "Fibroids" AND "Robotic surgical procedures" OR "Robotic assisted surgery" AND "Laparoscopy" OR "Uterine myomectomy" AND "Postoperative complications."
Methods Of Study Selection:
The initial search yielded 398 articles. After duplicate removal and application of selection criteria, 18 studies were included in the systematic review. Retrospective, prospective and non-randomized clinical studies evaluating clinical outcomes in women with symptomatic uterine leiomyomas undergoing robotic or laparoscopic myomectomy were included.
Tabulation, Integration, And Results:
A total of 2266 patients were analyzed (1199 underwent laparoscopic myomectomy and 1067 robotic myomectomy). Robotic myomectomy was associated with significantly lower blood loss (MD 36.35 mL; 95% CI 0.53-72.18) and lower conversion rates to laparotomy (relative risk [RR] 0.47 ; 95% CI: CI: 0.29-0.78) compared with laparoscopy. No significant differences were observed in transfusion rates (RR 1.03; 95% CI 0.76-1.70), postoperative complications (RR 1.06; 95% CI 0.67-1.59), or postoperative fever (RR 0.55; 95% CI 0.13-2.33).
Conclusion:
Robotic myomectomy demonstrated advantages over laparoscopy in terms of reduced blood loss and lower conversion rates to laparotomy. Other outcomes presented no significant differences between the two techniques. These findings support the safety of both approaches and may guide surgical decision-making based on patient characteristics and resource availability.