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WJOL S

10.5005/jp-journals-10033-1254
Pregnancy Outcomes following Robot-assisted Laparoscopic Myomectomy
REVIEW ARTICLE

Pregnancy Outcomes following Robot-assisted

Laparoscopic Myomectomy

Meghana Jetty

ABSTRACT myomectomy is the choice for women desiring uterine
Review study question: What are the characteristics of the preservation or future pregnancies. Although several
pregnancy outcomes in women undergoing robot-assisted prospective RCTs have shown that laparoscopic myomec­
laparoscopic myomectomy (RALM) for symptomatic leiomyo- tomy results in less postoperative morbidity and faster
mata uteri? recovery than open procedures, 21,34,35,37 the majority of

Summary answer: Despite a high prevalence of women with myomectomies are still performed by laparotomy. Reluc­
advanced maternal age, obesity and multiple pregnancy, the tance to adopt conventional laparoscopy has been attri­
outcomes are comparable with those reported in the literature buted to surgical difficulty in enucleating and extracting
for laparoscopic myomectomy.
myomas, and in performing multilayer closure using this
Study design: Review study. technique. 18,36 More recently, robot­assisted laparoscopic
Participants/material, setting, methods: An extensive myomectomy (RALM) has been performed by surgeons
search for articles related to the topic and review the studies. with the expectation that it could improve on the short­
1,7
Main results: The mean time to conception was 12 to 18 months. comings of traditional laparoscopy, and thereby offer an
Assisted reproduction techniques were employed in 22 to 24% approach more easily adoptable by gynecologic surgeons
of these women. Spontaneous abortions occurred in 18 to 20%. with access to a robot. Accumulating evidence suggests
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Preterm delivery prior to 35 weeks of gestational age occurred
in 17%. One uterine rupture was documented in all studies that robot­assisted compared with open myomectomy
together. Pelvic adhesions were discovered in 11 to 16% of results in less blood loss, fewer complications and faster
patients delivered by cesarean section. Higher preterm delivery recovery. 2,3,5 Several studies report that these short­term
rates were significantly associated with a greater number of outcomes are similar for robot­assisted and conventional
myomas removed and anterior location of the largest incision. 7,19,25,26
None of the myoma characteristics were related to spontane- laparoscopic myomectomy. Data also indicate that
ous abortion. robotic techniques can provide a minimally invasive
approach to removal of larger, more difficult myomas
Keywords: Myomectomy, Pregnancy outcomes, RALM,
Robotic surgery. that are less often attempted with traditional laparoscopic
surgery. 5,11 While these studies provide evidence that
How to cite this article: Jetty M. Pregnancy Outcomes follo-
wing Robot-assisted Laparoscopic Myomectomy. World J Lap RALM has favorable short­term outcomes, long­term
Surg 2015;8(3):85-89. outcomes, including pregnancy outcomes, have not yet
20
been repor ted in large series. Pregnancy following myo­
Source of support: Nil
mectomy is usually considered at a higher risk of compli­
Conflict of interest: None cations, such as uterine rupture and surgical obs tetrical
complications associated with the presence of peri­uterine
INTRODUCTION adhesions. 17,24,28 The present article is designed to review
the previous investigations to examine pregnancies and
Uterine leiomyomata are common in women of reproduc­
43
tive age. These benign neoplasms may become sympto­ perinatal outcomes as they related to characteris tics of
matic and can result in subfertility among those trying the myomas in women who underwent RALM.
31
to become pregnant. While hysterectomy is the most AIMS AND OBJECTIVES
6
frequent surgical treatment for symptomatic myomas,
To review various studies relating to robot­assisted
laparoscopic myomectomy and pregnancy outcomes and
Junior Consultant make a comprehensive understanding of future of RALM.
Department of Obstetrics and Gynecology, Apollo Speciality
Hospitals, Nellore, Andhra Pradesh, India MATERIALS AND METHODS
Corresponding Author: Meghana Jetty, Department of Extensive and thorough search was made in Google,
Obstetrics and Gynecology, Apollo Speciality Hospitals, Nellore PubMed, Highwire press, WALS website, SAGES website,
Andhra Pradesh, India, e-mail: meghareddy.smile@gmail.com
daVinci community, Researchgate.net, Paperity.org, Ncbi
World Journal of Laparoscopic Surgery, September-December 2015;8(3):85-89 85