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WJOLS
Pregnancy Outcomes following Robot-assisted Laparoscopic Myomectomy
Table 1: Pregnancy outcomes following robot-assisted myomectomy identified through various searches
Mean Mean size Entry into No. of Mean time SAB
Mean no. of of largest endome- preg- to preg- < 20 Live Live C- Uterine
First author No. of age myo- myoma trial cavity nan- nancy weeks preterm term section rupture
(year) patients (yrs) mas (cm) (%) cies (months) (%) (%) (%) (%) (%)
Robotic surgery
Pritts et al (2013) 31 107 34.8 3.9 7.5 20.6 127 13.9 18.9 12.6 59.8 95.7 1.1
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Lönnerfors et al (2011) 31 35 1 7 NR 18 10 16.7 0 55.6 50 0
Laparoscopic surgery
Liu et al (2010 and 2011) 18,19 83 32 NR 5.9 10.8 18 NR 11.1 44.4 44.4 NR NR
Malzoni et al (2003 and 350 34.3 2.5 6.3 NR 59 NR 13.6 5.1 81.4 55.9 0
2010) 22,23
Kumakiri et al (2008) 15 111 NR 3.5 6.6 11.7 111 NR NR NR NR 46.8 NR
Palomba et al (2006) 27 68 28 1 7.6 NR 36 5 11.1 2.8 86.1 71.9 0
Sizzi et al (2007) 40 2050 36.1 2.3 6.4 NR 386 NR 19.9 2.3 77.7 78 0.3
Paul et al (2006) 29 115 30 1 5 7.8 141 8.9 19.9 2.1 73 82.1 0
Seracchioli et al (2003 and 127 33.7 2.6 5.4 3.9 158 17.9 27.2 1.3 65.8 74.5 0
2006) 38,39
Kumakiri et al (2005) 14 40 34.5 3.2 6.8 5 47 13 23.9 2.2 67.4 40.6 0
Campo et al (2003) 8 68 34.3 2.9 4.4 NR 14 NR 7.1 0 92.9 30.8 0
Soriano et al (2003) 41 88 36.1 1.7 6.2 0 44 7.5 13.6 0 77.3 23.5 0
NR: No result; C-section: Cesarean section; No: Number
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abdominopelvic surgery. Ten myomas were removed 28% shown by Lonnerfors and Persson (2011) in their
weighing 256 gm, with the largest 10 cm in diameter prospective study of pregnancy in 31 women following
on the anterior surface of the uterus. The endometrial robotic surgery for deep intramural myomas: results
cavity was not entered. Hysterotomies were performed in the latter report also indicated that all miscarriages
using a monopolar electrosurgical instrument, and a occurred in pregnancies resulting from IVF. In contrast,
multilayered closure was performed. The uterine rupture the data show that miscarriages up to 20 weeks were
occurred on the posterior fundal aspect of the uterus at about evenly divided among those who conceived spon
33 weeks of gestation during precipitous labor. In addition, taneously and those who used ART. Myoma number
one uterine dehiscence was noted at the time of delivery and anterior location were significantly associated with
as an incidental finding and occurred in a patient with no preterm delivery up to 35 weeks of gestational age, even
remarkable surgical history or myoma characteristics. In after adjustment for other risk factors for preterm deli
the series, 34% of myomectomies were performed using very. The published myomectomy literature has limited
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monopolar electrosurgical energy. The rate of uterine comparable data but Roemisch et al (1996) reported
rupture in this study is consistent with data reported for that women who delivered at term had significantly
laparoscopic and open myomectomy, and lower than the fewer myomas than the group of women who deli
estimated risk of uterine rupture after a classical cesarean vered preterm, miscarried or had ectopic pregnancies.
section. 12,43,44 In a recent review of risk factors for uterine Given that this population often desires fertility and that
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rupture after laparoscopic myomectomy, Parker et al adhesions are known to cause infertility, it is an advan
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(2010) identified minimizing the use of electrosurgery tageous finding that the risk of adhesions may be lower
and performing multilayered closures as techniques than has been reported in both abdominal myomectomy
that could decrease the risk of rupture. An advantage of and laparoscopic myomectomy patients. 16,32,33,47 Since
RALM is the ability to perform an identical multilayer adhesion formation following myomectomy may reduce
closure to the abdominal approach that controls hemos fertility, formal secondlook laparoscopic studies in
tasis without the need for significant use of electrosur nonpregnant women following RALM may be needed
gical instruments. Owing to the risks of electrosurgery, for a more definitive measure of postoperative adhesion
ultrasonic energy can be utilized with the robot to per formation. A limitation of our study is the inability to
form the hysterotomy. 45,46 The robotic harmonic shears generalize these findings to other practices. The use of
are unable to articulate in a similar manner to all other magnetic resonance imaging (MRI) to determine the
robotic instruments, thus losing 2 of the 7º of freedom exact location of the myomas removed and also suturing
in movement. The observed miscarriage rate (19%) was of the hysterotomy defect in a multilayered fashion help
in the range of rates reported in the conventional lapa to minimize excessive bleeding, which typically results
roscopic myomectomy literature and was lower than the in conversions. In addition, the women in these studies
World Journal of Laparoscopic Surgery, September-December 2015;8(3):85-89 87
