Comparative analysis of robotic-assisted laparoscopic myomectomy versus traditional abdominal and laparoscopic myomectomy: A meta-analysis and systematic review

Uterine fibroids are the most common benign tumors affecting women of reproductive age, often requiring surgical intervention. This meta-analysis and systematic review compared the effectiveness, safety, and cost of three surgical approaches: robotic-assisted laparoscopic myomectomy (RLM), traditional abdominal myomectomy (AM), and laparoscopic myomectomy (LM). Following PRISMA guidelines, we systematically searched PubMed, EMBASE, and Google Scholar databases for studies published through January 2024, with no restrictions on publication date. Fifteen studies were included in the qualitative synthesis, and nine studies in the meta-analysis, comprising 2,559 patients. Our findings revealed that AM had significantly shorter operative time compared to RLM (mean difference: 82.54 minutes; 95% CI: -122.14, -42.93; P < 0.00001; I² = 94%). However, RLM was associated with significantly shorter hospital stays than AM (mean difference: 1.54 days; 95% CI: 1.31 to 1.77; P≤0.00001; I²=58%). No significant differences were found in operative time (mean difference: 36.47 minutes; 95% CI: -11.58, 84.51; P = 0.14) or blood loss between RLM and LM. Intraoperative bleeding (EBL >1000 mL) was most common in AM (7.0%) compared to RLM (1.3%) and LM (2.6%). Postoperative transfusion rates were highest in AM (20%), followed by LM (5.8%) and RLM (3.8%). The study demonstrated substantial heterogeneity (I² > 75% for most outcomes), attributed to differences in patient characteristics and study designs. In conclusion, RLM provides favorable outcomes with shorter hospital stays and fewer complications compared to AM, while showing comparable results to LM, though at potentially higher cost.