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.