OBJECTIVE:
To compare the surgical outcomes of robot-
assisted laparoscopic myomectomy (robot-assisted),
standard laparoscopic myomectomy (laparoscopic), and
open myomectomy (abdominal).
METHODS:
Myomectomy patients were identified from
the case records of the Cleveland Clinic and stratified
into three groups. Operative and immediate postopera-
tive outcomes were compared. Data analysis was per-
formed using analysis of variance, Kruskal-Wallis analysis
of ranks,
2
, and Fisher exact tests where appropriate.
RESULTS:
From a total of 575 myomectomies, 393
(68.3%) were abdominal, 93 (16.2%) were laparoscopic,
and 89 (15.5%) were robot-assisted. The three groups
were comparable regarding the size, number, and loca-
tion of myomas after adjusting for body mass index.
Significantly heavier myomas were removed in the robot-
assisted group (223 [85.25, 391.50] g) compared with the
standard group (96.65 [49.50, 227.25] g,
P
<
.001) and were
lower than in the abdominal group (263 [ 90.50, 449.00] g,
P
.002). Higher blood loss was reported in the abdomi-
nal group compared with the other two groups, with a
median (interquartile range) of blood loss in milliliters of
100 (50, 212.50), 200 (100, 437.50) and 150 (100, 200) in
the laparoscopic, abdominal, and robot-assisted groups,
respectively. The actual surgical time in minutes was 126
(95, 177) in the abdominal group, 155 (98, 200) in the
laparoscopic group, and 181 (151, 265) in robot-assisted
group (
P
<
.001). Patients in the abdominal group had a
higher median length of hospital stay of 3 (2, 3) days,
compared with 1 (0, 1) day in the standard group and 1 (1,
1) days in the robot-assisted group (
P
<
.001).
CONCLUSION:
Robotic-assisted myomectomy is asso-
ciated with decreased blood loss and length of hospital
stay compared with traditional laparoscopy and to open
myomectomy. Robotic technology could improve the
utilization of the laparoscopic approach for the surgical
management of symptomatic myomas.
(Obstet Gynecol 2011;117:1–1)
DOI: 10.1097/AOG.0b013e318207854f
LEVEL OF EVIDENCE:
I |
