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 ).