Robot‐assisted laparoscopic myomectomy for deep intramural myomas

Kang, So Yeon; Jeung, In-Cheul; Chung, Youn‐Jee; Kim, Hyun-Kyung; Mansukhani, Tanvi S.; Kim, Mee‐Ran

doi:10.1002/rcs.1742

Cited by 7 publications

(4 citation statements)

References 18 publications

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“…Uterine volume and myoma number and size were associated with increased TOT in our cohort. This is consistent with previous literature showing that in RALM, operative time is related to uterine volume [9], number of myomas removed, and size of those myomas [11]. Younger patient age and history of diabetes mellitus have not been previously associated with increased TOT; because there is no obvious biological factor that can be plausibility attributed to the association between younger patient age and TOT, this may be a spurious finding.…”

Section: Discussionsupporting

confidence: 91%

Predictors of Prolonged Operative Time for Robotic-Assisted Laparoscopic Myomectomy: Development of a Preoperative Calculator for Total Operative Time

Movilla

Orlando

Wang

et al. 2020

Journal of Minimally Invasive Gynecology

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Study Objective: To develop a preoperative calculator to predict the total operative time (TOT) for robotic-assisted laparoscopic myomectomy (RALM). Design: Retrospective cross-sectional study. Setting: University medical center. Patients: Women who underwent RALM performed by 3 high-volume surgeons at a single institution between January 2014 and December 2017. Interventions: Demographic characteristics, indication for surgery, surgical history, myoma burden on imaging, and TOT were collected. RALM operative time was classified as <3 hours, 3 to 5 hours, and >5 hours. We identified preoperative characteristics predictive of increased operative time and developed a preoperative calculator to estimate TOT. Measurements and Main Results: A total of 126 women underwent RALM during the study period, with a mean TOT of 213 minutes § 66 minutes. The mean total weight of myomas removed was 264 g § 236 g, and mean largest myoma diameter was 8.5 cm § 2.6 cm. Overall, mean number of myomas removed was 2.5 § 2.4, and estimated blood loss (EBL) was 215 § 212 mL. Five patients (4.0%) received a blood transfusion, and 4 patients (3.2%) underwent conversion to laparotomy. Preoperative factors significantly associated with TOT included patient age, personal history of diabetes mellitus, uterine volume, number of myomas, number of myomas >3 cm, diameter of the dominant myoma, and surgeon experience. The mean uterine volume was 282 cm 3 for procedures with a TOT <3 hours, 461 cm 3 for procedures with a TOT of 3 to 5 hours, and 532 cm 3 for procedures with a TOT >5 hours (p = .004). Body mass index, personal history of hypertension, previous abdominal/pelvic surgery, surgical indication, location of dominant myoma (anterior, posterior, or fundal) and classification of dominant myoma (submucosal, intramural, subserosal, or other) were not associated with TOT. Our preoperative calculator correctly predicted TOT category in 88% of the patients and estimated TOT within a 1-hour margin in 80% of patients. Conclusion: RALM is becoming a more popular surgical approach for the management of uterine myomas. Preoperative radiographic evaluation and a thorough patient history may enhance patient counseling and surgical planning. Uterine volume and myoma number and size appear to be more predictive of TOT compared with myoma location.

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Section: Discussionsupporting

confidence: 91%

Predictors of Prolonged Operative Time for Robotic-Assisted Laparoscopic Myomectomy: Development of a Preoperative Calculator for Total Operative Time

Movilla

Orlando

Wang

et al. 2020

Journal of Minimally Invasive Gynecology

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“…In a retrospective study, more than half of the patients became pregnant with a 70% caesarean section rate without a report of uterine rupture [33] . Uterine rupture was also not reported in a comparison study, in which long-term pregnancy and miscarriage rates did not significantly differ after robotic assisted, laparoscopic, or abdominal myomectomy [34] . In a study where deep intramural myomas were enucleated, the pregnancy rate reached 75% [35] .…”

Section: Fertility and Obstetrical Outcomes And Recurrencementioning

confidence: 83%

Current status on robotic assisted myomectomy

Kiss¹,

Svobodová²,

Karasek³

et al. 2021

MIS

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Uterine leiomyomas are common benign solid tumors of the uterus. While the presence of fibroids is rarely life threatening, they are associated with symptoms affecting quality of life and fertility. Myomectomy is a standard fertility-sparing surgery which should be considered for women suffering from fibroid-related symptoms who do not desire hysterectomy or any alternative treatment option. While open surgery is thought to be reserved for large and numerous myomas, mini-invasive methods as laparoscopy and robot-assisted surgery have evolved in the hands of experienced surgeons to also deal with these more complex cases. Robotic myomectomy has its advantages in lower blood loss, fewer complications, and shorter hospital stay over open surgery, whereas the comparison outcomes with laparoscopic myomectomy are still uncertain. Advantages of the wristed instruments, three-dimensional vision along with the incorporation of correct surgical techniques could emphasize the benefits of the robotic assisted approach in large and numerous myoma cases. Careful and detailed assessment should precede the surgery to recognize risks and steps to reduce operation time, which tends to be the most presented drawback of robotic myomectomy. As the tendency of robot-assisted surgeries is growing, many authors share their experience or publish comparison studies with other surgical methods. Our article describes the current status concerning robotic myomectomy, reviewing publications from the past five years (2016-2021).

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“…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 .…”

Section: Resultsmentioning

confidence: 99%

“…(NR, not reported; * the same study divided in two because of different groups; RALM, robotic-assisted laparoscopic myomectomy; CLM, conventional laparoscopic myomectomy; AM, abdominal myomectomy); Table S3: Da Vinci Surgical System and procedure characteristics and fibroid baseline characteristics (MMN, mean myoma number; MMD, mean myoma diameter; MDLM, mean diameter of largest myomas; MMW, mean myoma weight; NR, not reported). References [ 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 <...…”

mentioning

confidence: 99%

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

Tsakos¹,

Xydias

Ziogas

et al. 2023

JCM

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Background: Uterine fibroids are the most frequently diagnosed gynaecological tumours, and they often require surgical treatment (conventional laparoscopic myomectomy—CLM). The introduction and evolution of robotic-assisted laparoscopic myomectomy (RALM) in the early 2000s has expanded the range of minimally invasive options for the majority of cases. This study aims to compare RALM with CLM and abdominal myomectomy (AM). Methods and materials: Fifty-three eligible studies adhered to the pre-established inclusion criteria and were subsequently evaluated for risk of bias and statistical heterogeneity. Results: The available comparative studies were compared using surgical outcomes, namely blood loss, complication rate, transfusion rate, operation duration, conversion to laparotomy, and length of hospitalisation. RALM was significantly superior to AM in all assessed parameters other than operation duration. RALM and CLM performed similarly in most parameters; however, RALM was associated with reduced intra-operative bleeding in patients with small fibroids and had lower rates of conversion to laparotomy, proving RALM as a safer overall approach. Conclusion: The robotic approach for surgical treatment of uterine fibroids is a safe, effective, and viable approach, which is constantly being improved and may soon acquire widespread adoption and prove to be superior to CLM in certain patient subgroups.

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Robot‐assisted laparoscopic myomectomy for deep intramural myomas

Abstract: Robot-assisted laparoscopic myomectomy for deep intramural myomas could be a minimal invasive surgical option for women who wish preserve fertility. Copyright © 2016 John Wiley & Sons, Ltd.

Cited by 7 publications

References 18 publications

Predictors of Prolonged Operative Time for Robotic-Assisted Laparoscopic Myomectomy: Development of a Preoperative Calculator for Total Operative Time

Predictors of Prolonged Operative Time for Robotic-Assisted Laparoscopic Myomectomy: Development of a Preoperative Calculator for Total Operative Time

Current status on robotic assisted myomectomy

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

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