Robotic Myomectomy: The Complete Minimally Invasive Solution
Uterine myomas occur in 25-30% of reproductive age women. They are the cause for many of the 600, 000 hysterectomies performed annually in the U.S. Many women, however, wish to preserve their uterus and their future fertility. The AAGL stated this year that all women needing hysterectomy for benign disease should be offered a minimally invasive( MI) surgical approach. What will their position be regarding myomectomies?
Myomectomy can be challenging using traditional laparoscopic techniques. Myomas are often large, numerous, located in the posterior uterus or broad ligament. These challenging locations may lead to conversions or at best very long laparoscopic proceedures. The majority of myomectomies are still done through open incisions because of these limitations. The advent of barbed suture has made three layered closures easier but the most crucial aspect of a myomectomy is a successful uterine reconstruction, which will allow for future pregnancy if so desired.
Robotic myomectomy (RM) is a more flexible approach. Wristed instruments allow the surgeon to move around complex pathology. The ability to do easy intracaporeal suturing allows for quick and complex repairs of the uterine defects. There are no limitations by fibroid location, relative number or size ( as long as one can place laparoscopic ports..) The one limitation is lack of haptics which is overcome by practice. RM generally results in less blood loss, pain and fewer conversions to open surgery for the patient. This is a patient centric procedure. There are also better ergonomics for the surgeon.
I have followed 88 RM prospectively in my private practice and have followed 11 of their subsequent completed pregnancies, two pregnancies in progress ( second and third trimester) and three miscarriages ( first trimester) There were no placental abnormalities, no preterm labor or complications thus far. Based on this preliminary case series, I feel RM is the optimal way to offer reproducible, MIS surgery to patients requiring myomectomy. I think it will allow more patients’ access to MIS for their myomectomies. I will share data and video to demonstrate my point.
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