title: Robotic assisted vs laparoscopic and/or open myomectomy: systematic review and meta-analysis of the clinical evidence.
abstract: Uterine myomas are relative frequent in premenopausal women. The development of advanced minimally invasive surgical techniques proposed robotic-assisted myomectomy as an equally safe and effective treatment option.
  
  
  
  PubMed, Scopus and Cochrane databases were systematically searched and 15 studies met the inclusion criteria for our meta-analysis.
  
  
  
  Eight studies compared robotic technique to laparoscopic, while nine studies to open/abdominal technique. In total, 2,027 patients were included. In studies referring to the comparison between the robotic myomectomy and the open one, the robotic technique showed a significant inferiority in operative time [84.85 min per operation (95 % confidence intervals (CI) 60.41-109.29)], but superiority in estimated blood loss [92.78 ml/operation (95 % CI 47.26-138.29)], the need for transfusion [981 patients; odd ratio (OR) 0.20; 95 % CI 0.09-0.43], total complications (1101 patients; OR 0.31; 95 % CI 0.11-0.87) and in the length of hospital stay [1.84 days/patient (95 % CI 1.40-2.29)] over the open myomectomy.
  
  
  
  Regarding the comparison between robotic assisted and laparoscopic technique, no significant difference was found between the two in comparison groups. Minimally invasive techniques have the advantage of less blood loss, less need for blood transfusion and less hospital stay. Additionally, long-term outcomes still need to be clarified including pain control, fertility and pregnancy rates postoperatively, as well as possible recurrence rates.
authors.affiliation: Gynecological Oncology Department, Christie Hospital, Manchester, UK. christosiavazzo@hotmail.com.|, 38, Seizani Str., Nea Ionia, 14231, Athens, Greece. christosiavazzo@hotmail.com.
authors.forename: Christos
authors.initials: C
authors.lastname: Iavazzo
authors.affiliation: Department of Hygiene Epidemiology and Medical Statistics, University of Athens, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Mamais
authors.affiliation: First Department of Surgery, General Hospital of Attica "KAT", Athens, Greece.
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Gkegkes
mesh_terms: D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery; D007902:Length of Stay; D009364:Neoplasm Recurrence, Local; D061646:Operative Time; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D063186:Uterine Myomectomy / Q000379:methods*
keywords: Abdominal myomectomy; Laparoscopic myomectomy; Metanalysis; Myoma; Open myomectomy; Robotic myomectomy