Objective To compare approaches to myomectomy (laparotomic, laparoscopic, and robotic). To show the relationship between the number of fibroids and the reproduction diagnosis. Methods Observational, analytical, retrospective, and cross-sectional study; where the surgical approach used, was evaluated in terms of surgical bleeding, time, number and weight of fibroids and reproductive results. Results 69 patients were treated through different approaches and divided into 3 groups. The differences found among groups were in favor of laparotomic myomectomy in terms of the number ( p =0.000) and weight of fibroids ( p =0.004). Robotic surgery was also longer ( p =0.000). In the analysis of the influence of the number of fibroids to achieve pregnancy, the result was in favor of the minimally invasive routes, after surgery, both in the group of < 6 fibroids ( p =0.017), and that of > 6 fibroids ( p =0.001), without differences in the time from surgery to pregnancy ( p =0.979). Conclusions The surgical approach decision should consider the number and size of resected fibroids, surgical time, and reproductive diagnosis. The minimally invasive route should be offered whenever possible due to its better outcome on achieving pregnancy, without forgetting the benefits of laparotomy, while also accrediting the recently introduced robotic-assisted approach.

Determinar el riesgo de transmisión de COVID-19 durante procedimientos quirúrgicos asistidos por robot y mínimamente invasivos, y establecer recomendaciones para la reactivación de la cirugía robótica en México durante la pandemia por COVID-19. Métodos: Se revisaron las declaraciones de las sociedades quirúrgicas nacionales e internacionales sobre el riesgo de transmisión de COVID-19 durante los procedimientos robóticos y de mínimo acceso. Además, se revisó la literatura disponible sobre COVID-19 y otras transmisiones virales en neumoperitoneo con CO 2 , así como la presencia de virus en aerosol creado por electrocauterio durante estos procedimientos. Las recomendaciones de las sociedades se compararon con la literatura disponible sobre el tema para crear nuestra revisión y recomendaciones para la reactivación de la cirugía robótica en México. Resultados: Las recomendaciones promulgadas por varias sociedades quirúrgicas evolucionaron con el tiempo a medida que se disponía de más información sobre la transmisión de COVID-19. No hay evidencia de la presencia de COVID-19 en el aerosol creado por electrocauterio o el CO 2 durante la cirugía robótica o de mínimo acceso. Existen tecnologías para reducir la liberación de neumoperitoneo de CO2 en la sala de operaciones, así como para filtrar las partículas virales, que deberían reducir el riesgo de exposición del personal de la sala de operaciones. El protocolo preoperatorio requiere de prueba de imagen con tomografía axial computada y RT-PCR-SARS-CoV-2 previo ABSTRACT Objectives: To determine the risk of COVID-19 transmission during minimally invasive and robot-assisted surgical procedures and to establish recommendations for the reactivation of robotic surgery in Mexico during the COVID-19 pandemic. Methods: The statements of the national and international surgical societies were reviewed on the risk of COVID-19 transmission during robotic and minimally invasive procedures. In addition, the available literature on COVID-19 and other viral transmissions in CO 2 plume, as well as the presence of aerosolized viruses created by electrocautery during these procedures, was reviewed. The recommendations of the societies were compared with the available literature on the subject to create our recommendations for the reactivation of robotic-assisted surgery in Mexico. Results: Recommendations promulgated by various surgical societies evolved over time as more information on COVID-19 transmission became available. There is no evidence of the presence of COVID-19 in the aerosol created by electrocautery or CO 2 during robotic or minimally invasive surgery. Technologies exist to reduce the release of CO 2 pneumoperitoneum in the operating room, as well as to filter viral particles, which should reduce the risk of exposure of operating room personnel. The preoperative protocol requires negative imaging with computed axial tomography and RT-PCR-SARS-CoV-2 prior to the surgical procedure to guarantee the safety of the patient and the health personnel. Conclusions: Reactivation www.me...

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Los leiomiomas son el tumor pélvico más común en la mujer, éstos pueden afectar la fertilidad. La miomectomía es el tratamiento de elección en pacientes con leiomiomas sintomáticos y fines reproductivos. Se pueden realizar mediante distintas técnicas, como laparotomía, laparoscópica o asistida por robot. Múltiples estudios pretenden determinar si alguno de estos abordajes resulta superior a otro. Con este estudio se busca obtener información para elegir la mejor vía de abordaje en cada paciente. Objetivo: Describir y comparar tres tipos de abordaje para la realización de miomectomía: Asistida robóticamente, laparoscópica, laparotomía. Determinar si existe superioridad entre los tres diferentes abordajes para miomectomía. Material y métodos: Estudio retrospectivo, analítico y observaciones donde se revisaron 150 casos de miomectomías en sus distintos abordajes realizados en

Surgeons who practice robotic surgery in benign gynecological conditions agree that in some cases, blood loss and transfusions are reduced, the time of hospital stay and of reintegration to daily activities is less, although commonly in the first cases of each surgeon surgical time may be longer than laparoscopic surgery depending on the learning curve of each. As in any other surgical technique, it is important that the surgeon is trained and certified in accordance with the guidelines that each hospital institution indicates for the practice of robotic surgery and is constantly updated through the tools provided by robotic surgery to ensure the correct use of this technology and always maintain the skill looking for the safety of the patient at all times. Uterine fibroids, are the most common benign tumors that appear in women of reproductive age. Depending on their location, number and size, the symptoms they produce vary in frequency and severity. Robotic myomectomy has shown that with a surgical team that operates frequently, it is superior to conventional laparoscopic myomectomy, even in the area of ​​cost/benefit. Robotic myomectomy is an accessible, efficient and flattering pathway for patients with fibroids who want a pregnancy.