Eligibility criteria
The research question at the core of this review was structured using the PICOS (population-intervention-comparator-outcome-study design) format, in order to ensure that the sought data and outcomes were precisely defined beforehand, a strategy also supported by the recommendations of the Cochrane Collaboration (8 ). The target population of this review were women with uterine fibroids, regardless of clinical manifestations, who received surgical treatment of said fibroids. This study excluded pediatric populations and mesenchymal tumors arising at different anatomical regions. The intervention investigated was Robotic Assisted Laparoscopic Myomectomy (RALM). Given the rise of various surgical platforms and methodologies (9-11 ), the investigated intervention was further refined to the multi-port variant, defined as the use of at least one robotic port for camera placement and two additional robotic ports for the robotic arms and instruments, with the optional third robotic port and/or accessory port(s). Furthermore, the investigated robotic platform was the Da Vinci Surgical System, given both its prevalence in the available literature, as well as for the sake of methodological homogeneity.
Comparators were not mandatory for study inclusion, however were crucial for comparative meta-analysis; thus Conventional Laparoscopic Myomectomy (CLM) and Abdominal Myomectomy (AM) were both included as eligible comparators. The primary sought outcomes of this study were the metrics of surgical performance consistent enough in the available literature to facilitate comparison of the approaches; namely mean operation duration (MOD), estimated blood loss (EBL), hospitalization duration or length of stay (LOS), transfusion rate, complication rate and conversion to laparotomy rate for RALM and CLM. Secondary outcomes included symptom improvement and fertility outcomes for women wishing to conceive post-operatively. Acceptable study designs were either prospective or retrospective case series, cohorts, case-control studies and clinical trials. Single case reports or secondary studies were excluded from this analysis.