COMPARISON OF SURGICAL OUTCOMES BETWEEN REDUCED-PORT ROBOTIC SURGERY, SINGLE PORT LAPAROSCOPY AND CONVENTIONAL LAPAROSCOPY FOR MYOMECTOMY

To date, few studies have compared the benefits of different surgical modalities for myomectomy. The purpose of this study was to compare the surgical outcomes and postoperative pain scores of reduced-port robotic myomectomy (RPRM) with those of single-port laparoscopic myomectomy (SPLM) and conventional laparoscopic myomectomy (CLM). Retrospective study Data were obtained from medical records of patients who underwent RPRM (n=99) between September 2017 and September 2019. The cases were compared with patients who underwent SPLM (n=74) between December 2013 and September 2017 and who underwent CLM (n=80) between July 2017 and August 2019. The same surgeon performed SPRM and RPRM, and different oncologists performed CLM according to preference. RPRM might have been selected for convenience if the patient had many or large myomas after RPRM had started. Therefore, different periods of data were used for RPRM and SPLM to reduce selection bias. Robotic myomectomy usually requires 4 ports. However, for cosmetic benefits, 3 ports were used, which are called "reduced-port”. Patients rated pain for 1, 6, and 24 hours after surgery on the 11-point NRS (0 = no pain, 10 = worst pain). Operative time of RPRM included setup and docking time. Patient basal characteristics and surgical outcomes between the 3 groups were analyzed using Welch, Kruskal-Wallis, Bonferroni, and Pearson chi-square statistically. There were no differences in basal characteristics (i.e., parity, history of previous abdominal surgery, number, size and location of the largest myoma, and weight of myomas) between the 3 groups. The largest myoma’s mean size was 7.3 cm for SPLM, 7.8 cm for CLM, and 8.1cm for RPRM. The mean number of myomas was 1.8 for SPLM, 2.0 for CLM, and 2.3 for RPRM. The total number of myomas ranged from 1 to 5 in all groups. The surgical outcomes (i.e., estimated blood loss, postoperative hemoglobin drop, conversion to multi-port surgery or laparotomy, and complication) were not different significantly between the 3 groups. There was bladder dilatation in 3 patients (1 in SPLM, 2 in RPRM). Wound dehiscence occurred in 8 patients (4 in SPLM, 4 in RPRM). CLM had 3 major complications including wound infection, ileus, or hematoma. This required long-term and re-hospitalization. Operative time was significantly longer in the RPRM than CLM (121.3±48.7 vs. 100.9±38.2 min; p=0.002). SPLM's postoperative hospital stay was significantly shorter than RPRM and CLM (1.97±0.2 vs. 2.07±0.3 vs. 2.24±0.9 days; p=0.003). But, there was no period difference between the RPRM and CLM. Pain scores were significantly lower in the RPRM and CLM compared with SPLM at 1, 6 and 24 hours after surgery (3.3±1.4 vs. 3.3±1.4 vs. 4.5±1.6 at 1hr; p<0.001, 3.3±0.7 vs. 3.1±0.4 vs. 3.8±1.0 at 6hr; p<0.001, 3.1±0.8 vs. 2.9±0.5 vs. 3.1±0.7 at 24hr; p=0.014). Most operative outcomes were similar among the three surgical modalities except operative time. The postoperative pain score was significantly lower in the RPRM and CLM than SPLM. RPRM is a safe and feasible option for removing myomas with outcomes similar to SPLM and CLM.