Robotic, Abdominal Myomectomy Equally Effective

Robotic-assisted laparoscopic myomectomy and abdominal myomectomy were equally effective in improving patient outcomes, but other results for surgical, quality-of-life, and residual fibroids outcomes varied, according to the findings of a small study.

“The use of robotic assistance greatly facilitates a surgeon’s ability to perform laparoscopic myomectomy and expands the scope of eligible patients,” study authors wrote. “Recent studies comparing robotic-assisted laparoscopic myomectomy and abdominal myomectomy have shown that the introduction of robotic technology may allow patients who typically would have undergone laparotomy, because of large myoma size or location, to undergo a laparoscopic procedure with equivalent or better intraoperative and immediate postoperative outcomes.”

However, to date, few studies have compared the outcomes of robotically-assisted surgery to standard abdominal myomectomy.

In this analysis, outcomes from 16 patients who underwent robotic-assisted laparoscopic myomectomy were compared with outcomes from 23 patients who underwent abdominal myomectomy. All patients had presented with uterine size less than 20 weeks. For follow-up, all patients underwent an ultrasound at 12 weeks postsurgery and participated in a telephone interview at 6 weeks postsurgery to discuss quality-of-life outcomes.

Overall, patients undergoing both procedures reported similar reduction in symptoms and overall satisfaction.

Patients who underwent robotic-assisted laparoscopic myomectomy had operative times that were twice as long as those who underwent abdominal myomectomy (261.1 minutes vs 124.8 minutes; P<0.001). Robotic-assisted laparoscopic myomectomy was also associated with 3-fold higher unfavorable difference in operative efficiency (73.7 g vs 253.0 g of specimen removed per hour; P<0.05).

However, patients who underwent robotic-assisted laparoscopic myomectomy had shorter hospital stays (1.5 days vs 2.7 days; P<0.001) and were more likely to return to work within 30 days (85.7% vs 45.0%; P<0.05). In addition, there was a trend toward more patients who underwent robotic-assisted laparoscopic myomectomy discontinuing narcotic use within 1 week of surgery.

Unfortunately, the use of robotic-assisted laparoscopic myomectomy was also associated with a greater residual fibroid volume compared with abdominal myomectomy (17.3 cm³ vs 3.4 cm³, respectively; P<0.05).

“In counseling patients seeking robotic-assisted laparoscopic myomectomy, the risks of residual fibroids and recurrence of symptoms, as well as the potential need for reoperation, should be discussed and balanced with the numerous surgical and patient satisfaction benefits of minimally invasive surgery,” the researchers wrote. “Ultimately, surgeons can minimize these risks with appropriate preoperative evaluation, counseling, and patient selection.”

Pertinent Points:
- Robotic-assisted laparoscopic myomectomy was as effective as abdominal myomectomy but resulted in a shorter hospital stay and faster return to work.
- Choice of minimally invasive procedure should be balanced against potential for residual fibroids.

References:

Griffin L, Feinglass J, Garrett A, et al. Postoperative outcomes after robotic versus abdominal myomectomy. JSLS. 2013;17:407-413.