Robotic-assisted, laparoscopic and open myomectomy: a comparison of surgical outcomes

Abstract

OBJECTIVE: To compare the surgical outcomes of robotic-assisted laparoscopic myomectomy (RM), standard laparoscopic myomectomy (LM) and open myomectomy (OM). DESIGN: Retrospective,case-matched analysis. MATERIALS AND METHODS: All patients who underwent RM between 2008 and 2009,LM and OM between 1995 and 2009 at Cleveland Clinic were included.The 3 groups were compared regarding the baseline demographics,operative and immediate postoperative outcomes associated with each type of surgery.Data analysis was performed using analysis of variance, Wilcoxon's rank sum test,Chi-square and Fisher exact tests where appropriate. RESULTS: From a total of 575 myomectomies,393(68.3%) were OM,93(16.2%) were LM,and 89(15.5%) were RM.The median (IQR) BMI of patients was 26.7 (22.9, 31.3) kg/m2.The three groups were comparable regarding size,number,and location of myomas after adjusting for age and BMI. Significantly heavier myomas were removed in the RM group 223.00(85.25,391.50)gm compared to the LM group 96.65 (49.50,227.25)gm (p<0.001)and was lower than the OM group 263.00 (90.43,448.25)gm (p=0.002).The RM group has significantly lower (P<0.001)blood loss compared to the OM and the LM groups with mean ± SD of blood loss in ml is 100.00(50.00, 212.50),200.00(100.00, 437.50)and 150.00 (100.00, 200.00)respectively.Total surgical time in minutes was 176.50(138.00, 225.00) in the OM, 222.00(147.00,268.00) in the LM and 200.00(167.75,261.00) in the RM (P<0.001).Patients in the OM had significantly higher median length of hospital stay of 3(2,3) days; compared to 1(0,1) in the LM and 1(1,1) days in the RM (p<0.001). CONCLUSION: Robotic assisted myomectomy is associated with decreased estimated blood loss,and length of hospital stay compared to traditional laparoscopy and to open myomectomy.Despite the robotic use is associated with longer OR time compared to open procedures it is shorter than the laparoscopic approach.It appears that robotic technology is able to convert more laparotomy cases to laparoscopic cases than traditional laparoscopy alone.