Reproductive outcomes following robotic myomectomy
Keywords:Infertility, Leiomyoma, Robotics, Robotic surgical procedures, Uterine myomectomy
Background: To assess pregnancy outcomes of patients following robotic myomectomy.
Methods: Retrospective chart review was performed of 336 patients following robotic myomectomy at a university hospital from June 2006 to May 2013. Patients were called to obtain delivery outcomes.
Results: Three hundred and thirty-six women had the following: mean age of 41.97 +/- 12.3 years (range 24-55), mean BMI of 24.6 +/- 4.96, mean of 3.37 +/- 3.1 fibroids removed (range 1-21), and mean weight of 352.28 +/- 339.56 grams of fibroids removed. Approximately 66.9% (N=250) provided pregnancy outcome data with 119 (47.6%) attempting pregnancy after surgery. Eighty-three (69.7%) achieved a total of 91 pregnancies. Less than half of these patients underwent cesarean section, and no cases of uterine rupture. Eighty-seven patients had known infertility pre-surgery; 22 underwent intrauterine insemination resulting in 12 pregnancies, and 34 underwent in vitro fertilization resulting in 25 pregnancies. A total of 53 (60.9%) of patients with infertility achieved 60 total pregnancies.
Conclusions: The fertility rate after robotic myomectomy for patients attempting to conceive (69.7%) and for those with known infertility who continued to attempt pregnancy postoperatively (60.9%) were similar. There was a low incidence of complications associated with pregnancies conceived after robotic myomectomy.
Chittawar P, Franik S, Pouwer AW. Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Cochrane Database of Systematic Reviews. 2014;10:CD004638.
Buttram VC, Reiter RC. Uterine leiomyomata. Fertil Steril. 1981;36:433-45.
Baird DD, Dunson DB, Hill MC. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188:100-7.
Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol. 1990;94(4):435-8.
Falcone T, Parker WH. Surgical management of leiomyomas for fertility or uterine preservation. Obstet Gynecol. 2013;121:856-68.
Cardozo ER, Clark AD, Banks NK. The estimated annual cost of uterine leiomyomata in the United States. Am J Obstet Gynecol. 2012;206:211.
Practice Committee of the American Society for Reproductive Medicine. Myomas and reproductive function. Fertil Steril. 2006;86:194-99.
Pritts EA. Fibroids and infertility: a systematic review of the evidence. Obstet Gynecol Surv. 2001;58:483-91.
Heertum KV, Barmat L. Uterine fibroids associated with infertility. Women’s Health 2014;10(6):645-53.
Brady PC, Stanic AK, Styer AK. Uterine fibroids and subfertility: an update on the role of myomectomy. Current Opinion in Obstetrics and Gynecology. 2013;25(3):255-9.
Casini ML, Rossi F, Agostini R. Effect of the position of fibroids on fertility. Gynecol Endocrinol. 2006;22:106-9.
Surrey ES, Lietz AK, Schoolcraft WB. Impact of intramural leiomyomata in patients with a normal endometrial cavity on in vitro fertilization-embryo transfer cycle outcome. Fertil Steril. 2001;75:405-10.
Rackow BW, Taylor HS. Submucosal uterine leiomyomas have a global effect on molecular determinants of endometrial receptivity. Fertil Steril. 2010;93:2027-34.
Sunkara SK, Khairy M, El-Toukhy T. The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis. Hum Reproduction. 2010;25(2):418-29.
Oliveira, Flávio Garcia. Impact of subserosal and intramural uterine fibroids that do not distort the endometrial cavity on the outcome of in vitro fertilization–intracytoplasmic sperm injection. Fertil Steril. 2004;81(3):582-7.
Practice Committee of American Society for Reproductive Medicine in collaboration with Society of Reproductive Surgeons. Myomas and reproductive function. Fertil Steril. 2006;86:194-9.
Ascher-Walsh CJ, Capes TL. Robot-assisted laparoscopic myomectomy is an improvement over laparotomy in women with a limited number of myomas. J Minim Invasive Gynecol. 2010;17:306-10.
Dubuisson JB, Chavet X, Chapron C. Uterine rupture during pregnancy after laparoscopic myomectomy. Hum Reprod. 1995;10:1475-7.
Bulletti C, Polli V, Negrini V. Adhesion formation after laparoscopic myomectomy. J Am Assoc Gynecol Laparosc. 1996;(3)533-6.
Dubuisson JB, Fauconnier A, Deffarges JV. Pregnancy outcome and deliveries following laparoscopic myomectomy. Hum Reprod. 2000;15(4)869-73.
Claeys J, Hellendoorn I, Hamerlynck T. The risk of uterine rupture after myomectomy: a systematic review of the literature and meta-analysis. Gynecol Surg. 2014;11:197-206.
Seracchioli R, Manuzzi L, Vianello F. Obstetric and delivery outcome of pregnancies achieved after laparoscopic myomectomy. Fertil Steril. 2006;86:159-65.
Sizzi O, Rossetti A, Malzoni M. Italian multicenter study on complications of laparoscopic myomectomy. J Minim Invasive Gynecol. 2007;14:453-62.
Cela V, Freschi L, Simi G. Fertility and endocrine outcome after robot-assisted laparoscopic myomectomy (RALM). Gynecological Endocrinology. 2013;29(1)79-82.
Pitter MC, Gargiulo AR, Bonaventura LM. Pregnancy outcomes following robot-assisted myomectomy. Hum Reprod. 2013;28:99-108.
Goldberg J, Pereira L. Pregnancy outcomes following treatment for fibroids: Uterine fibroid embolization versus laparoscopic myomectomy. Curr Opin Obstet Gynecol. 2006;18:402-6.
leiomyomata on the results of in-vitro fertilization treatment. Hum Reprod. 1995;10:2576-8.
Lonnerfors C, Persson J. Pregnancy following robot-assisted laparoscopic myomectomy in women with deep intramural myomas. Acta Obstetricia et Gynecologica Scandinavica. 2011;90(9):972-7.
Tusheva OA, Gyang A, Patel SD. Reproductive outcomes following robotic-assisted laparoscopic myomectomy (RALM). Journal of Robotic Surgery. 2013;7(1):65-9.
Metwally M, Cheong YC, Horne AW. Surgical treatment of fibroids for subfertility. Review. The Cochrane Collaboration. 2012;11:1-37.
Sudik R, Husch K, Steller J. Fertility and pregnancy outcome after myomectomy in sterility patients. European Journal of Obstetrics and Gynecology and Reproductive Biology. 1996;65(2)209-14.
Wilcox AJ, Weinberg CR, O’Connor JF. Incidence of early loss of pregnancy. N Engl J Med. 1988;319:189-94.
American College of Obstetricians and Gynecologists. Early pregnancy loss. ACOG Practice Bulletin 150. Washington, DC: ACOG; 2015.
Pitter MC, Srouji SS, Gargiulo AR. Fertility and symptom relief following robot-assisted laparoscopic myomectomy. Obstetrics and Gynecology International. 2015;2015:1-9.
Koo Y, Lee J, Yoo L. Pregnancy outcomes and risk factors for uterine rupture after laparoscopic myomectomy: a single-center experience and literature review. Journal of Minimally Invasive Gynecology. 2015;22(6):1022-8.
Harris WJ. Uterine dehiscence following laparoscopic myomectomy. Obstet Gynecol. 1992;80:545–546.
Bannerman CG, Gilbert S, Landon MB. Risk of uterine rupture and placenta accreta with prior uterine surgery outside of the lower segment. 2012;120(6):1332-7.
Tsuji S, Takahashi K, Imaoka I. MRI evaluation of the uterine structure after myomectomy. Gynecol Obstet Invest. 2006;61:106-10.
Barakat EE, Bedaiwy MA, Zimberg S. Robotic-assisted, laparoscopic, and abdominal myomectomy: a comparison of surgical outcomes. Obstet Gynecol. 2011;117:256-65.
Zhang Y, Hua KQ. Patients' age, myoma size, myoma location, and interval between myomectomy and pregnancy may influence the pregnancy rate and live birth rate after myomectomy. J Laparoendosc Adv Surg Tech. 2014;24(2):95-9.