The feasibility of robot-assisted laparoscopic myomectomy: Compared with standard laparoscopic and abdominal myomectomy

Abstract

OBJECTIVE: To compare robotic myomectomy to laparoscopic and open myomectomy. METHODS: We retrospectively analyzed medical records of patients undergoing myomectomy between January 2007 and March 2011. Patients were stratified into three groups by surgical approach. Clinical features and surgical outcomes were compared. RESULTS: From a total of 206 myomectomies, 31 (15%) were robotic, 70 (34%) were laparoscopic, and 105 (51%) were open. Heavier myomas were removed in the robotic group (164.3 +/- 193.7 g) than in the laparoscopic (117.3 +/- 132.7 g) group but were lighter than the myomas removed in the open group (284.7 +/- 265.6 g) (P = 0.002; open vs. laparoscopic). Greater blood loss was reported in the open and robotic groups than in the laparoscopic group with a mean blood loss of 456.6 +/- 288.5 mL, 380.6 +/- 303.8 mL, and 198.5 +/- 137.6 mL, respectively (P < 0.001; open vs. laparoscopic, P = 0.004; robot vs. laparoscopic). Actual surgical time was 272.5 +/- 116.8 minutes in the robotic, 172.1 +/- 49.4 minutes in the laparoscopic (P < 0.001; robot vs. laparoscopic), and 152.3 +/- 45.3 minutes in the open group (P < 0.001; robot vs. open). Patients in the robotic group had shorter mean length of hospital stay of 4.1 +/- 1.4 days as compared to 5.5 +/- 1.3 days in the open (P < 0.001; robot vs. open) but there were no significant differences between the robotic and laparoscopic groups (3.8 +/- 1.0 days). CONCLUSION: Laparoscopic group is associated with decreased blood loss but significantly smaller myomas when compared with the other two groups. However, robotic myomectomy does not fall behind open myomectomy in terms of myoma size or surgical outcomes. In conclusion, robotic myomectomy can replace the role of open myomectomy.