Conclusion
The robotic approach for uterine fibroids management is a safe,
effective and viable approach, which is constantly improving and in time
may surpass its current drawbacks. Further research is required, in
particular randomized studies to provide further insight into the
subject.
Keywords: myomectomy, Da Vinci, robotic gynaecologic surgery, uterine fibroids, minimally invasive
Introduction
Uterine fibroids, also referred to as leiomyomas or simply myomas, are
among the most prevalent gynaecological disorders, with ultrasonographic
findings indicative of their presence being detected in up to 80% of
women by the age of 50 years (1 ).
While in their majority remain asymptomatic and are diagnosed
incidentally (2 ), uterine fibroids
may cause manifestations such as pelvic pain, abnormal uterine bleeding,
dysmenorrhea and mass effect, leading to disturbed urinary,
gastrointestinal and sexual dysfunction. More insidiously, they may also
be the cause of secondary infertility, emotional distress, anxiety or
depression, with a significant effect on overall quality of life
(3 ).
Considering the above, effective treatment is paramount, not only for
symptom alleviation, but also to improve future fertility prospects.
While a plethora of non-invasive options for myoma management are
available, surgical treatment remains the gold standard
(4 ) with minimally invasive surgery
in particular offering considerable advantages and being most frequently
the preferred option (5 ). Amongst
the most advanced minimally invasive options is robotic assisted
laparoscopic myomectomy (RALM) with the use of the Da Vinci Surgical
System, offering impressive three dimensional visualization
capabilities, natural, wrist-like control of surgical instruments and
superior ergonomics (6 ). These
technical advantages in theory contribute to the increase of
intra-operative efficiency, control and safety and thus to improved
surgical outcomes with fewer complications and morbidity. In this
systematic review we will examine this hypothesis, namely whether these
technical advantages improve RALM’s safety and effectiveness of
conventional laparoscopic myomectomy (CLM) and abdominal myomectomy
(AM).
Methods and Materials
This is a systematic review conducted based on pre-established criteria
and on the methodology suggested by the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA 2020) recommendations
(7 ).