Department of Obstetrics and Gynecology, Western University, London, ON, Canada.
Department of Obstetrics and Gynecology, Université de Montréal, Montreal, QC, Canada.
J Robot Surg. 2024 Apr 29;18(1):184. doi: 10.1007/s11701-024-01953-3.
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.
探讨机器人手术在子宫肌瘤剔除术中相较于腹腔镜和开放手术的作用、益处和局限性。本综述通过 CENTRAL、PubMed、Medline 和 Embase 等数据库检索截至 2023 年 5 月 1 日的数据。纳入了比较机器人子宫肌瘤剔除术与开放或腹腔镜手术临床结局的全文研究,无语言限制。最初发现 2150 条记录。最终纳入了 24 项研究进行定性和定量分析。两位研究者独立按照 PRISMA 指南评估所有报告。使用软件“Review Manager Version 5.4”进行荟萃分析。使用纽卡斯尔-渥太华量表评估偏倚风险。当可行时进行敏感性分析。在机器人与腹腔镜子宫肌瘤剔除术的比较中,肌瘤重量和最大肌瘤大小方面无显著差异。机器人子宫肌瘤剔除术出血量较少,但输血率相似。两种方法的并发症发生率和手术时间相似,但一些机器人研究显示手术时间较长。转换率有利于机器人手术。住院时间差异较大,但无总体显著差异,两种方法的妊娠率相似。与开放子宫肌瘤剔除术相比,开放手术处理更大、更重的肌瘤。它们失血更多,但机器人手术需要的输血更少。开放手术的并发症发生率略高。开放手术一般更快,术后疼痛评分相似,但开放手术的住院时间更长。机器人和开放方法的妊娠率相似。机器人手术在子宫肌瘤剔除术中具有优势,可提供更好的暴露和灵活性,减少出血,改善患者结局。PROSPERO 注册号:CRD42023462348。