New Surgical Technique for Robotic Myomectomy: Continuous Locking Suture on Myoma (LSOM) Technique

Abstract

Robot-assisted laparoscopic myomectomy (RALM) has broadened the indications even in complex myomas. However, the high cost of RALM remains the main disadvantage. Therefore, a surgical technique that can reduce the cost of RALM and still has the advantages of robotic surgery is required. We propose a “locking suture on myoma (LSOM)” technique and compared the operative and perioperative outcomes of patients who underwent RALM with or without the LSOM technique. We included 337 patients who underwent RALM with (n = 160) or without (n = 177) the LSOM technique between March 2019 and August 2020. The LSOM group had low parity and gravidity, with a low rate of Cesarean sections. Myoma type was not different between the groups; however, patients in the LSOM group had larger, heavier, and higher number of myomas, although fewer patients had multiple myomas and were discharged earlier. Total operating time, estimated blood loss, pre- and postoperative hemoglobin levels, transfusion rate, and postoperative fever were not different between the two groups. In conclusion, the LSOM technique may be a viable surgical option for myomas, as it can reduce the cost of RALM by obviating the need for robotic Tenaculum forceps.

Robotic Single-Site Plus Two-Port Myomectomy versus Conventional Robotic Multi-Port Myomectomy: A Propensity Score Matching Analysis

“…To the best of our knowledge, this is the first cohort study to have evaluated surgical outcomes of RSTM versus those of CRM. Although there have been two studies on RSTM [ 8 , 9 ], there is none that has weighed the pros and cons of RSTM against CRM’s.…”

Single-Incision versus Multiport Robotic Myomectomy: A Propensity Score Matched Analysis of Surgical Outcomes and Surgical Tips

“…Surgeons will experience more collisions among not only instruments but also trocars during SIRM using the single-site or single-port systems than during MPRM. Fifth, in cases of multiple myomas, our previously described LSOM technique is a simple and cost-effective surgical technique for RALM that can be readily performed by inexperienced surgeons [25,26]. The LSOM technique can reduce the OT by obviating the time for finding the removed myomas in the pelvic cavity [25].…”

“…Myomas were retrieved from the uterus using robotic or laparoscopic tenaculum forceps in the usual manner or with the locking suture on myoma (LSOM) technique without the need for tenaculum forceps, as previously described [25,26]. The uterine myometrium and serosa were sutured layer by layer (in two or three layers) using a continuous running suture technique with absorbable barbed suture materials, including 1-0 Monofix PDO (Samyang, Daejeon, South Korea), 1-0 V-Loc™ suture (Covidien, Mansfield, MA, USA), or 1-0 Quill™ SRS bidirectional barbed suture (Angiotech Pharmaceuticals Inc., Vancouver, BC, Canada).…”

Differentiated Thyroid Cancer: A Health Economic Review

“…The costs of novel surgical approaches such as robotic transaxillary thyroidectomy and transoral endoscopic thyroidectomy vestibular approach (TOETVA), which have as the main feature avoiding a neck scar [ 71 ], are yet to be evaluated from a health economics point of view. The widespread use of robotic thyroid surgery in Korea has been ascribed to extensive government support, economic interests, and the higher surgical fees associated with the technique [ 72 ]. One analysis has compared transoral endoscopic thyroidectomy vestibular approach and transcervical approach thyroidectomy but omitted conventional surgery as a control.…”