Comparison of operative and fertility outcomes of single-incision robotic myomectomy: a retrospective single-center analysis of 286 cases

Reproductive outcomes of high-intensity focused ultrasound ablation and myomectomy for uterine fibroids: a systematic review and meta-analysis

RESEARCH QUESTION

Does high-intensity focused ultrasound (HIFU) ablation have comparable reproductive outcomes to myomectomy for patients with uterine fibroids?

DESIGN

A systematic review and a meta-analysis of data extracted from published studies up to March 2024.

RESULTS

Through a more structured analysis, HIFU treatment yielded a pooled pregnancy rate of 23.3% (95% CI 11.5 to 37.6%) and a pooled live birth rate (LBR) of 17.3% (95% CI 7.8 to 29.3%), significantly lower than those after myomectomy, which had a pooled pregnancy rate of 56.9% (95% CI 45.6 to 67.9%) and a pooled LBR of 44.1% (95% CI 34.9 to 53.4%) (P = 0.0001 and P = 0.0003, respectively). After controlling for patient age, ultrasound-guided HIFU studies reported significantly lower pregnancy rate and LBR compared with myomectomy. Moreover, studies enrolling younger patients and explicitly recruiting those desiring to conceive reported better reproductive outcomes.

CONCLUSIONS

Patients with uterine fibroids undergoing HIFU treatment and desiring to preserve their uteri resulted in poorer reproductive outcomes compared with myomectomy. Although uterine fibroids are now the number one disease that receives HIFU treatment worldwide, the overall quality in design and execution of HIFU studies on reproductive outcomes for women with uterine fibroids leaves much room for improvement. Above all, comparative trials against the standard of care are badly needed.

Role of single port robotic surgery in gynecology

Robot-assisted Single-Site Laparoscopy (R-LSS) is a rapidly evolving minimally invasive technique. Although it is a very recent technology, the use of R-LSS have been increasingly report in gynecology, for both benign and malignant indications. This review aims to summarize the evolution of this innovative technique and to examine its feasibility and safety for gynecological surgical procedures. We evaluated studies dealing about R-LSS in gynecological surgery. We performed a comprehensive literature research on PubMed and the Cochrane Library in February 2024. Based on the study reviewed, R-LSS seems to be a feasible and effective alternative to other mini-invasive approach in gynecological surgery. R-LSS combine the advantages of robotics surgery with the aesthetic result of a single incision. Compare to Single-Site Laparoscopy, it restore triangulation of the instrument and improve visualization and ergonomic. R-LSS seems to be related to favourable intra-e post-operative outcomes. Although, further studies would be necessary allow us to draw any final conclusion.

Single incision robotic myomectomy: selection criteria, learning curve and cost

The article "Comparison of operative and fertility outcomes of single-incision robotic myomectomy: a retrospective single-center analysis of 286 cases" by Kim et al. compares the effectiveness of robotic single-port myomectomy against the traditional multiport approach. The study finds similar operating outcomes, complication rates, and pregnancy rates in expert hands for both methods. Our systematic review supports these findings, revealing no significant differences in operative time, blood loss, or complication rates. Recent meta-analysis further emphasizes the benefits of the single-port approach in reducing morcellation time, overall operative duration, and blood loss. Our letter seeks insights on patient selection criteria to minimize conversion rates between surgical approaches and inquiries on learning curve differences. Additionally, we seek cost analysis details for both techniques. We appreciate the authors' valuable contributions to this field.