Robotic-assisted vs. laparoscopic and abdominal myomectomy for treatment of uterine fibroids: a meta-analysis

Uterine fibroids are extremely common uterine neoplasms. However, whether robotic-assisted laparoscopic myomectomy (RALM) is superior to laparoscopic myomectomy (LM) or abdominal myomectomy (AM) is still debatable. Consequently, we aimed to compare the three currently major surgical techniques used in patients with uterine fibroids. We searched the PubMed, the Cochrane Library, MEDLINE, Embase, and Web of Science databases up to April 22, 2017. The meta-analysis included 20 studies involving 2852 patients. The number of complications [odd ratio (OR) 0.52, p = 0.009], estimated blood loss (EBL) [weighted mean difference (WMD) = 33.03, p = 0.02], conversions (OR 0.34, p = 0.03), and postoperative bleeding (OR 0.18, p = 0.03) in RALM cases was significantly less than that for LM. The numbers of complications (OR 0.56, p = 0.03), length of hospital stay (WMD -1.74, p < 0.00001), EBL (WMD -77.74, p < 0.00001), and numbers of transfusions (OR 0.25, p < 0.0001) were significantly decreased, and the operative time (WMD 84.88, p < 0.00001) was significantly prolonged in RALM cases when compared to AM cases. Compared with LM and AM, RALM is associated with significantly fewer complications, significantly lower EBL, significantly fewer conversions than both LM and AM, and significantly less bleeding than LM.