Laparoscopic Versus Robotic-Assisted Laparoscopic Myomectomy for Enucleation of Posterior Myomas

INTRODUCTION: Uterine fibroids affect 70–80% of women in the United States. Surgical management with myomectomy can be performed via various surgical modalities, including laparoscopic or robotic-assisted laparoscopic techniques. This choice is often influenced by surgeon preference, patient characteristics, and fibroid location. Enucleation of posterior myomas can often pose unique challenges due to the relative difficulty of removal and suturing on the posterior aspect of the uterus. OBJECTIVE: To investigate differences in operative outcomes after laparoscopic versus robotic-assisted laparoscopic myomectomy for posterior myomas. METHODS: We performed a retrospective analysis of all patients undergoing laparoscopic or robotic-assisted myomectomy between January 2018 and December 2021 at an urban tertiary academic center. All surgeries were performed by fellowship-trained gynecologic surgeons. Data on patient demographics, operative details, and postoperative outcomes were collected. RESULTS: A total of 102 myomectomies were included in the study, 50 (49%) were laparoscopic and 52 (51%) robotic-assisted. Mean age for both groups was 36 years. 42.2% of patients identified as Black and 31.4% as White. Average supply cost for laparoscopic myomectomy cases was $2494 versus $4484 for robotic-assisted cases. There was no significant difference in mean estimated blood loss between laparoscopic and robotic myomectomies for posterior myomas (194 mL vs. 178 mL, p=0.46). There was no significant difference in mean operative time between laparoscopic and robotic myomectomies (287 minutes vs. 208 minutes, p=0.33). There was no significant difference in the mean size of the largest fibroid removed between laparoscopic and robotic myomectomies (5.7 cm vs. 5.9 cm, p= 0.67). There was no significant difference in mean total number of fibroids removed between laparoscopic and robotic myomectomies (3.4 vs. 4.7, p=.096). The rate (10%) of unplanned overnight admissions did not differ between groups. There were no cases of readmission or reoperation in either group. CONCLUSIONS: There were no significant differences in operative times, estimated blood loss, or unplanned admissions in laparoscopic versus robotic-assisted myomectomies performed for posterior myomas. A similar number and size of posterior fibroids were removed during laparoscopic and robotic procedures. There was a trend towards significance demonstrating a greater number of fibroids removed during robotic surgery. Our findings suggest that route of myomectomy for posterior myomas should be driven by surgeon proficiency in the chosen surgical modality.