Feasibility and surgical outcomes of robotic myomectomy for large and multiple uterine fibroids- insights from a decade of experience at a single centre.

Abstract

There is limited data on the safety and effectiveness of robotic-assisted myomectomy (RM) for large (≥ 8 cm) and multiple (≥ 5) fibroids. This study aims to assess the feasibility and perioperative outcomes of RM in these cases. A retrospective chart review was performed on 260 patients who underwent RM at a single institution between January 2013 and May 2024. Demographic information, primary symptoms, and operative outcomes were extracted from the patients' medical records. Large myomas were defined as those with a diameter of ≥ 8 cm, while multiple myomas were considered to be ≥ 5 fibroids. Data from 260 patients, with a mean age of 34.18 ± 5.55 years, were collected and analyzed. On average, 2.37 ± 0.31 fibroids were removed, with a mean weight of 294.0 ± 290.25 g. The average operative time was 144.6 ± 55.3 min, including a console time of 100.3 ± 47.13 min. The estimated blood loss (EBL) averaged 189.05 ± 296.65 mL, with 6.9% (18 patients) requiring transfusions. The mean hospital stay was 23.46 ± 6.42 h, with 87 patients staying more than 24 h. No conversions to laparotomy, reoperations, or major complications were reported. Patients with fibroids ≥ 8 cm experienced significantly higher EBL (p = 0.019), transfusion rates (p = 0.041), and longer hospital stays (p = 0.009). Although total operative time was not significantly affected by the number of fibroids, docking (p = 0.036) and console times (p < 0.001) were longer in patients with ≥ 5 fibroids. Additionally, blood transfusions were more frequently required in this group. Drawing on ten years of experience, this study highlights the feasibility and efficacy of RM in treating uterine myomas larger than 8 cm and in cases involving five or more fibroids.