Reproductive outcomes following robotic assisted laparoscopic myomectomy (RALM)

Abstract

To assess reproductive outcomes following RALM. Retrospective chart review. Female patients of reproductive age (19-55) who underwent RALM were eligible for inclusion. Patients' medical charts were reviewed and confirmed with hospital records. Statistical comparison was done by t-test. The study analyzed reproductive outcomes in patients who underwent RALM under the care of one surgeon. Of 36 eligible patients, six (17%) were lost to follow up. In thirty patients with follow up data (83%), the number of uterine myomas varied from 1 to 5 with the largest tumor diameter between 3 and 17 cm. Sixteen patients (53%) were interested in conception following RALM. Of those interested, twelve patients (75%) were able to successfully conceive, while four patients (25%) were unable to conceive. Of those who conceived, eight patients (67%) reported natural conception within 6 cycles of unprotected intercourse, while four patients (33%) utilized assisted reproductive technologies to conceive. Among those who successfully conceived, one patient (8%) miscarried due to advanced reproductive age. Two patients (17%) experienced premature delivery at 28 and 32 weeks respectively. Both incidents were caused by premature rupture of membranes, however, the uterine musculature was intact. All deliveries (100%) were performed via cesarean section. No surgical complications were reported following RALM. There were no cases of scar separation at the incision site (0%). The average number of myomas in those who delivered was estimated at 1.8 compared to 3.5 in those unable to conceive (P<0.05), and the average age was 34 compared to 41 respectively (P<0.05). To the best of our knowledge, this is the largest retrospective cohort study assessing pregnancy outcomes following RALM. Our pregnancy rate (75%) combined with a low incidence of complications supports the need for a multicenter trial to further evaluate effectiveness and safety of RALM in terms of pregnancy outcomes.