Clinical experience of robotic myomectomy for fertility preservation using preoperative magnetic resonance imaging predictor

Abstract

Objective This study aimed to demonstrate the use of preoperative magnetic resonance imaging (MRI) findings to select the optimal surgical technique between single-site (SS) and multi-site (MS) robotic myomectomy based on clinical experience, for the preservation of fertility. Methods Ninety-eight patients who underwent SS or MS robotic myomectomy using the da Vinci ® Si system after undergoing MRI were evaluated retrospectively. The correlation between preoperative MRI findings and the intraoperative or postoperative findings during robotic myomectomy for the preservation of fertility was analyzed. The reproductive outcome was investigated when the patient wished to conceive. Results The mean age of the patients was 35.68±5.04 years and 80 patients (81.6%) were nulliparous. The total diameter of myomas on MRI was 106.75±54.52 mm. The number of resected myomas was 4.31±4.39 (range, 1-27), and the total weight of resected myomas was 293.11±281.13 (range, 30-1,260) g. Myomas with high signal intensity on MRI required less time for resection. MS robotic myomectomy was performed for an increased number and total diameter of a myoma or a deep-seated myoma.Postoperatively, all patients resumed normal menstruation. Of the 15 patients who wished to conceive, 12 (80%) conceived successfully. Of these, uterine dehiscence occurred in 1 patient and 10 patients underwent an uneventful cesarean section. Conclusion SS or MS robotic myomectomy can be recommended for patients who wish to conserve fertility. However, the optimal surgical technique should be selected based on preoperative MRI findings to predict an effective surgical process and the successful preservation of fertility.

Multi-Port Robotic-Assisted Laparoscopic Myomectomy: A Systematic Review and Meta-Analysis of Comparative Clinical and Fertility Outcomes

“…The initial pool of 955 studies, which resulted from the preliminary search of the medical databases, was refined via manual screening of the title and abstract, leading to 107 reports being moved to full-text assessment. Through constant evaluation and strict application of the pre-established inclusion criteria, 53 studies were ultimately included in this review [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ]. This systematic process of selection is summarised in Figure 1 .…”

Robotic single‐port hysterectomy versus robotic multisite hysterectomy in benign gynecologic diseases: A retrospective comparison of clinical and surgical outcomes

“…To our knowledge, this is the first study comparing the two recent technologies of robotic hysterectomy using the new da Vinci SP surgical system and the da Vinci Xi multiport system with reduced ports. Our group has suggested clinical information about robotic surgeries for endometriosis, 11 adenomyosis 12 and myoma, 13,14 especially for a single‐site system 15 so far as the new SP system 5 . On the basis of our experience, we would like to establish a practical guideline to help surgeons for choosing the pertinent robotic technique and assist with the steep learning curve.…”

Single-Site Robotic Myomectomy without Accessory Instrument Compared with Two-Port Laparoscopic Myomectomy: A Propensity Score Matching Analysis

“…For myomectomy, MRM is commonly used, and the majority of studies have compared MRM and LM [3][4][5][6]. Two meta-analyses concluded no inferiority and no significant short-term surgical benefits of MRM over LM.…”

“…Recently, the advent of robotic surgery has resulted in advantages such as three-dimensional stereoscopic vision and magnification, use of an articulating instrument, tremorfiltration, and reduced operation fatigue. Among robotic techniques, multi-port robot-assisted myomectomy (MRM) has been reported as a safe, minimally invasive surgery [3][4][5][6]. Accordingly, single-site robotic myomectomy (SSRM) is expected to provide further potential advantages, such as better cosmesis with higher patient acceptability, to umbilical single-site surgery.…”