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Enhancing surgical performance: the role of robotic surgery in myomectomies, a systematic review and metanalysis

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Abstract

Examine the role, benefits, and limitations of robotic surgery in myomectomies compared to laparoscopic and open surgical approaches. This review sourced data from CENTRAL, Pubmed, Medline, and Embase up until May 1, 2023. Full articles comparing clinical outcomes of robotic myomectomy with open or laparoscopic procedures were included without language restriction. Initially, 2150 records were found. 24 studies were finally included for both qualitative and quantitative analyses. Two investigators independently assessed all reports following PRISMA guidelines. Meta-analysis was conducted using the software “Review Manager Version 5.4”. Risk-of-bias was assessed using the Newcastle–Ottawa scale. Sensitivity analysis was conducted, when feasible. In a comparison between robotic and laparoscopic myomectomies, no significant difference was observed in fibroid weights and the size of the largest fibroid. Robotic myomectomy resulted in less blood loss, but transfusion rates were comparable. Both methods had similar complication rates and operative times, although some robotic studies showed longer durations. Conversion rates favored robotics. Hospital stays varied widely, with no overall significant difference, and pregnancy rates were similar between the two methods. When comparing robotic to open myomectomies, open procedures treated heavier and larger fibroids. They also had greater blood loss, but the robotic approach required fewer transfusions. The complication rate was slightly higher in open procedures. Open surgeries were generally faster, postoperative pain scores were similar, but hospital stays were longer for open procedures. Pregnancy rates were comparable for both robotic and open methods. Robotic surgery offers advancement in myomectomy procedures by offering enhanced exposure and dexterity, leading to reduced blood loss and improved patient outcomes. PROSPERO registration: CRD42023462348.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Western University, London, ON, Canada

    Ali Mourad

  2. Department of Obstetrics and Gynecology, Université de Montréal, Montreal, QC, Canada

    Ali Mourad, Carole Kamga-Ngande & Roland Antaki

  3. Miacleo fertility clinic Montreal, Montreal, QC, Canada

    Carole Kamga-Ngande

  4. Faculty of Medicine, School of Population and Global Health, McGill University, Montreal, QC, Canada

    Obey Albaini

  5. Ovo fertility clinic Montreal, Montreal, QC, Canada

    Roland Antaki

  6. Centre Hospitalier de l’Université de Montréal (CHUM), 900, Saint-Denis Street, Montreal, QC, H2X 3H8, Canada

    Roland Antaki

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  1. Ali Mourad
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Contributions

AM: Contributed to the conception and design of the study, data collection, data analysis and interpretation, statistical analysis, and manuscript preparation. CKN: Involved in the conception and design of the study, data analysis and interpretation, and manuscript preparation. OA: Participated in the conception and design of the study and data analysis and interpretation. RA: Engaged in the conception and design of the study, data analysis and interpretation, and manuscript preparation.

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Correspondence to Roland Antaki.

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Mourad, A., Kamga-Ngande, C., Albaini, O. et al. Enhancing surgical performance: the role of robotic surgery in myomectomies, a systematic review and metanalysis. J Robotic Surg 18, 184 (2024). https://doi.org/10.1007/s11701-024-01953-3

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