Background: To compare the clinical outcomes and treatment efficiencies
of advanced surgical treatments including High-Intensity Focused Ultrasound
(HIFU), robotic surgery and laparoscopic surgery in the uterine fibroid patients.
Methods: A total of 512 studies from 1995 to 2021 were identified by
screening from Science Direct, Cochrane library, Medscape, Willey Online Library,
PubMed, and Taylor Francis. From these studies 29 articles were qualitatively
included in our systematic review and 24 of them considered quantitively eligible
were included in the meta-analysis. Study analyzed by pooling the weighed mean
difference (WMD) with the 95% confidence interval (CI) were study provided as a mean + (SD) and pooled
risk ratio (RR) was expressed for dichotomous variables. Pooled results were
assessed with either a random-effect or fixed-effect model. Heterogeneity was
evaluated using the I statistic. Results: Comparison of HIFU and
robotic surgeries with operation times of 86.13 36.37 minutes to 120.2
63 minutes and 166 48.5 minutes to 278 67 minutes were
higher significant differences (I = 97%, p 0.00001), (WMD
–111.88 [–189.68, –34.08]) with statistically significant (p =
0.005). Comparison of HIFU and laparoscopic surgery in operation time of 86.13
36.37 minutes to 120.2 63 minutes and 79 30 minutes to
106.4 38.5 minutes were not statistically significant (p =
0.75) with higher significant differences heterogeneity (I = 96%,
p 0.00001), (5.51 [–27.82, 38.83]). Comparison of between blood
losses and fibroid sizes at 154 75 mL to 278 164.6 mL and 6.52.9 cm to 13.6 3.1 cm respectively in laparoscopic
surgery was higher significant differences (I = 91%, p
0.0007), (WMD 202.29 [87.77, 316.80]) with statistically significant (p
= 0.0005). Between hospital stay and blood loss in laparoscopic surgery at 1.2
0.9 days to 5.4 0.2 days and 200 107 mL to 278 164.6 mL showed significant differences (I = 90%, p
0.0001), (WMD –269.71 [–361.33, –178.09]) with statistically significant
(p 0.00001) while in robotic surgery was not significant. The follow
up uterine fibroid symptom & health-related quality of life questionnaire (UF-QOL) at 3 months 45.3 + 26.9 to 70.6 + 26.9 in fibroids group and 61.6 +
41.4 to 79.64 + 17.91 in adenomyosis group and both shows significantly different
(I = 83%, p = 0.02), (WMD 14.08 [4.42, 23.75]) with statistically
significant (p = 0.0004) and (I = 97%, p 0.00001),
(WMD –15.95 [–28.06, –3.84]) with (p = 0.010). SSS follow up 3 months
27.2 + 15.7 to 36.6 + 7.9 in fibroids of HIFU, the heterogeneity test showed
significant differences (I = 95%, p 0.00001), (WMD 16.22
[8.33, 24.11]) with statistically significant (p 0.0001). In terms
of pregnancy outcome, delivery outcome in live birth between HIFU and
laparoscopic surgery 4 (8) within 165 (219) and (7) 23 within 158 (224), the
heterogeneity was not significant (I = 0%, p = 0.44), (RR 1.06
[0.97, 1.17]) neither with for risk of delivering was not significant (p
= 0.20). Conclusions: HIFU treatment reveals more efficient clinical and
treatment outcomes than robotic or laparoscopic surgery, including improved
symptoms, absence of bleeding, shorter operative time, shorter recovery time, and
good benefits in both short-term and long-term quality-of-life.