Sinha Rooma, Rupa Bana, Raina Rohit, Bag Moumita, Hk Deepika, Reddy Padmapriya
Gynecology, Apollo Health City, Hyderabad, IND.
Cureus. 2024 Sep 26;16(9):e70232. doi: 10.7759/cureus.70232. eCollection 2024 Sep.
Introduction Robotic-assisted laparoscopic myomectomy (RALM) is being increasingly performed for large and multiple uterine myomas because of precise surgery and offers many short-term benefits over conventional surgeries; however, long-term effects in terms of reproductive outcome are not studied well. Our study aims at finding the pregnancy rate after RALM. We also studied secondary outcomes (rate of live births after RALM, conception technique (spontaneous or in-vitro fertilization (IVF)), and the correlation between pregnancy outcome and size, position, and number of fibroids removed. Methods and materials A single-center, retrospective observational study was conducted with patients who underwent RALM for fertility enhancement from August 2012 to May 2023 in the Department of Gynecology to know fertility outcomes. The RALM was performed using da Vinci Si and Xi. Results Out of 243 cases of RALM, 114 cases were operated for fertility enhancement (21 were lost to follow-up, and seven were not in the conception period). The outcome was analyzed for 86 patients (54 primary and 32 secondary infertility). The mean age was 31.99 ±4.53 years, and the mean fibroid weight was 347.83 ± 259.72 g. Forty-nine cases conceived spontaneously (six abortions) and 37 cases by IVF (12 failed, five abortions). The mean time to conception was 13.95 ± 4.82 months. All 63 cases were delivered by cesarean section (44 cases at 37-38 weeks, 17 cases at 36 weeks due to associated comorbidities, and two twin pregnancies delivered at 35 weeks). The pregnancy rate was 74/86 (86.04%) and the live births rate was 63/86 (73.25%). No statistical difference was found regarding the number of fibroids removed (p = 0.570) and size (p = 0.285) with pregnancy outcome. None of the myoma characteristics were related to abortion. Conclusion In our study, RALM was found to be an effective method for fertility enhancement.
引言 由于手术精准，机器人辅助腹腔镜子宫肌瘤切除术（RALM）越来越多地用于治疗大的多发性子宫肌瘤，与传统手术相比，它具有许多短期优势；然而，关于生殖结局的长期影响尚未得到充分研究。我们的研究旨在确定RALM术后的妊娠率。我们还研究了次要结局（RALM术后的活产率、受孕技术（自然受孕或体外受精（IVF）），以及妊娠结局与所切除肌瘤的大小、位置和数量之间的相关性。方法和材料 对2012年8月至2023年5月在妇科接受RALM以提高生育能力的患者进行了一项单中心回顾性观察研究，以了解生育结局。RALM手术使用达芬奇Si和Xi系统进行。结果 在243例RALM病例中，114例因提高生育能力而接受手术（21例失访，7例未处于受孕阶段）。对86例患者（54例原发性不孕和32例继发性不孕）的结局进行了分析。平均年龄为31.99±4.53岁，平均肌瘤重量为347.83±259.72克。49例自然受孕（6例流产），37例通过IVF受孕（12例失败，5例流产）。平均受孕时间为13.95±4.82个月。所有63例均通过剖宫产分娩（44例在37 - 38周，17例因合并症在36周，2例双胎妊娠在35周分娩）。妊娠率为74/86（86.04%），活产率为63/86（73.25%）。在所切除肌瘤的数量（p = 0.570）和大小（p = 0.285）与妊娠结局之间未发现统计学差异。肌瘤的任何特征均与流产无关。结论 在我们的研究中，RALM被发现是一种提高生育能力的有效方法。
