Robot‐assisted laparoscopic myomectomy; a feasible technique for removal of unfavorably localized myomas

摘要

OBJECTIVE: To describe the feasibility of robot-assisted laparoscopic myomectomy for unfavorably localized myomas using the da Vinci surgical system. DESIGN: Prospective observational. SETTING: University hospital. METHOD: Between April 2006 and March 2008, a robot-assisted laparoscopic myomectomy was performed on 13 women selected for having deep intramural myomas with probable impact on fertility and/or later pregnancy. The alternative surgical approach for all 13 was myomectomy via laparotomy. A transvaginal ultrasonography (TVUS) mapping of the myomas was performed to enable an optimal approach during surgery. Using a prospective protocol, relevant times at the operating theater as well as postoperative and follow-up data, were obtained. RESULTS: Median time for surgery was 132 minutes (range 94-209 minutes). Median blood loss was 50 ml (range 25-200 ml). No significant complication occurred during or after surgery. Median postoperative hospital stay was one day (range 1-3 days). At follow-up, including TVUS, no unexpected residual myomas larger than 5 mm were identified. Of eight women with an active wish for conception, six have become pregnant a median time of 15 months after surgery. All additional symptoms associated with the myomas were alleviated. CONCLUSION: Robot-assisted laparoscopic myomectomy is a feasible technique for removal of deep intramural myomas unfavorably localized for traditional laparoscopy. The properties of the da Vinci robot facilitate dissection and suturing comprising the major surgical parts of myomectomy.