Robotic-assisted, laparoscopic, and abdominal myomectomy: a comparison of surgical outcomes.
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 postoperative outcomes were compared. Data analysis was performed using analysis of variance, Kruskal-Wallis analysis of ranks, χ2, 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 location. Significantly heavier myomas were removed in the robot-assisted group (223 [85.25, 391.50] g) compared with the laparoscopic 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 abdominal 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 laparoscopic group and 1 (1, 1) days in the robot-assisted group (P<.001).


CONCLUSIONS
Robotic-assisted myomectomy is associated 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.


METHODS
II.
From Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Florida, Weston, Florida; Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio; the Department of Obstetrics and Gynecology, Benha University, Benha, Egypt; and the Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt.
Ehab E
EE
Barakat
Mohamed A
MA
Bedaiwy
Stephen
S
Zimberg
Benjamin
B
Nutter
Mohsen
M
Nosseir
Tommaso
T
Falcone
D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012371:Robotics / Q000706:statistics & numerical data; D016896:Treatment Outcome; D063186:Uterine Myomectomy / Q000379:methods* / Q000706:statistics & numerical data*
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