Robotically Assisted Laparoscopic Myomectomy: A Canadian Experience

Objective: To compare operative and immediate postoperative outcomes of robotically assisted laparoscopic myomectomy (RALM) and open myomectomy. Methods: We conducted a retrospective review of 38 cases of RALM performed in women of reproductive age with symptomatic uterine fibroids between October 2008 and February 2011. Twenty-one cases of open myomectomy were used as historical controls. Operative and immediate postoperative outcomes were compared. Data analysis was performed using Student t test, chisquare test, and analysis of covariance where appropriate. Results: The two groups were comparable in age, body mass index, parity, and symptoms. Up to 12 fibroids were resected robotically with a mean diameter of 9.1 +/- 2.0 cm and a mean weight of 389 +/- 170 g (range 73 to 900 g). RALM was associated with less blood loss (decrease in hemoglobin concentration 25.6 +/- 12.0g/L) than open myomectomy (37.7 +/- 20.1 g/L) (P = 0.018). Adjusting for baseline levels, postoperative hemoglobin levels were 99 g/L and 88 g/L in the robotic and open groups, respectively (P = 0.005). RALM was associated with shorter hospitalization (1.2 +/- 0.5 vs. 2.5 +/- 0.6 days, P < 0.001) and longer operating times (189.7 +/- 71.5 vs. 92.5 +/- 33.0 minutes, P < 0.001). Three patients in the open myomectomy group and one in the robotic group required blood transfusion. One patient in the robotic group developed lumbar plexopathy postoperatively. Conclusion: Robotically assisted laparoscopic myomectomy is associated with less blood loss and shorter hospital stay than myomectomy by laparotomy. Accumulating evidence of the risks and benefits of RALM will contribute to enhancing access to this technology on the part of women and their surgeons.