Pregnancy outcomes following robot-assisted myomectomy

Pitter, Michael C.; Gargiulo, Antonio R.; Bonaventura, Leo M.; Lehman, Jeff; Srouji, Serene S.

doi:10.1093/humrep/des365

Cited by 108 publications

(83 citation statements)

References 43 publications

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“…Most uterine ruptures after LM occur during the third trimester [7]. The reported rate of uterine rupture that can be attributed to LM is 1% [8]. Hurst et al [9] reviewed 21 different studies involving a total of 626 patients who had pregnancies following LM.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Perinatal Outcomes after Laparoscopic Myomectomy versus Abdominal Myomectomy

Fukuda

Tanaka

Kamada

et al. 2013

Gynecol Obstet Invest

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Background/Aims: To compare the perinatal outcomes after laparoscopic myomectomy (LM) versus abdominal myomectomy (AM). Methods: The medical records of 105 Japanese females who delivered after myomectomy from 2004 to 2012 at Osaka Medical College were reviewed retrospectively. Results: Of the 105 females who delivered after myomectomy, 48 had undergone LM and 57 had undergone AM. There were no significant differences in the perinatal outcomes including the rates of emergency cesarean sections, preterm deliveries, placental abnormalities, pregnancy-induced hypertension, low Apgar score, non-reassuring fetal heart rate patterns, and intrauterine fetal death. No significant difference was observed in the incidence of post-partum hemorrhage. There was no uterine rupture in either group. 15 (31%) of the females who had LM were candidates for transvaginal delivery, and 14 delivered vaginally (93% success rate). In contrast, 20 (35%) of the females who had AM were candidates for transvaginal delivery, and 19 delivered vaginally (95% success rate). Conclusion: There were no significant differences in the perinatal outcomes between the females who had LM and AM. Moreover, both groups had a high rate of successful transvaginal delivery after selecting the appropriate candidates.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Perinatal Outcomes after Laparoscopic Myomectomy versus Abdominal Myomectomy

Fukuda

Tanaka

Kamada

et al. 2013

Gynecol Obstet Invest

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“…Prior studies have reported a post-RALM cesarean section rate of 95.7% and a wide range of cesarean section rates after laparoscopic myomectomy (23.5% to 82.1%). 25 A recent Cochrane Systematic Review reported no significant difference in the rate of cesarean section after open and laparoscopic myomectomy (OR 0.59, 95% CI 0.13 to 2.72). 24 The considerably lower rate of cesarean section in our patients may have been influenced by the greater interval of time from the procedure and when they began actively attempting to conceive.…”

Section: Discussionmentioning

confidence: 98%

“…20,[22][23] Similarly, the rate of uterine rupture following RALM has been reported anywhere between 0 to 1.1%. 24,25 Since we first began to perform RALM in our institution, we have maintained a database concerning patient outcomes after undergoing this procedure. The objective of this study was to report post-operative fertility rates and pregnancy outcomes of a large series of patients who had a RALM with a single surgeon at Mount Sinai Hospital from June 2006 to May 2013.…”

Section: Introductionmentioning

confidence: 99%

Reproductive outcomes following robotic myomectomy

Shaia

Sekhon

Rosen

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: To assess pregnancy outcomes of patients following robotic myomectomy.Methods: Retrospective chart review was performed of 336 patients following robotic myomectomy at a university hospital from June 2006 to May 2013. Patients were called to obtain delivery outcomes.Results: Three hundred and thirty-six women had the following: mean age of 41.97 +/- 12.3 years (range 24-55), mean BMI of 24.6 +/- 4.96, mean of 3.37 +/- 3.1 fibroids removed (range 1-21), and mean weight of 352.28 +/- 339.56 grams of fibroids removed. Approximately 66.9% (N=250) provided pregnancy outcome data with 119 (47.6%) attempting pregnancy after surgery. Eighty-three (69.7%) achieved a total of 91 pregnancies. Less than half of these patients underwent cesarean section, and no cases of uterine rupture. Eighty-seven patients had known infertility pre-surgery; 22 underwent intrauterine insemination resulting in 12 pregnancies, and 34 underwent in vitro fertilization resulting in 25 pregnancies. A total of 53 (60.9%) of patients with infertility achieved 60 total pregnancies.Conclusions: The fertility rate after robotic myomectomy for patients attempting to conceive (69.7%) and for those with known infertility who continued to attempt pregnancy postoperatively (60.9%) were similar. There was a low incidence of complications associated with pregnancies conceived after robotic myomectomy.

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“…Due to its simplified suturing method, and the possibility of uterine reconstruction, robotic surgery yields similar results and is associated with similar rupture rates as the open procedure, especially in this setting. In a population of 107 patients, Pitter et al (12) reported 92 births and only one case of uterine rupture. Since these patients are still young, they benefit greatly from the minimally invasive approach in terms of long-term sequela, such as adhesions or weakness of the abdominal wall.…”

Section: Application In Benign Gynecological Diseasesmentioning

confidence: 99%

Robotic surgery in gynecology

Alkatout

Mettler

Maass

et al. 2016

J Turkish German Gynecol Assoc

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Review 224 Robotic surgery in gynecologyRobotic surgery is a dynamic development for minimally invasive procedures. The specialty of gynecology consistently offers new opportunities for innovative surgical techniques and the advancement of existing therapy approaches (Figure 1). Ever since the American FDA granted approval of the Da Vinci operation robot for gynecological operations in 2005, about three million robotic operations have been performed worldwide. 3500 Da Vinci systems are currently in use: 586 of these in Europe and 77 in Germany (4 th quarter of 2015). According to the figures of Intuitive Surgical, about 600,000 interventions were performed on a worldwide basis in the year 2014, of which 50% were performed in gynecology, approximately 30% in urology, and about 20% in general and chest surgeries. In 2011, the proportion of robotic hysterectomies performed for benign indications in the USA was as high as 27% (1). Currently, we have experience in robotic surgery for the majority of gynecological operations and fields of application. The known advantages of minimally invasive surgery, such as less blood loss, shorter durations of hospital stay, and lower patient morbidity compared to open procedures, have been observed here as well. Better exposure of the operating field by 3D technology and the extension of surgical instruments to 7 degrees of freedom permit the use of minimally invasive surgery, even for complex indications. Robot-assisted manipulation of the instruments permits tremor-free handling and reduces work fatigue for the surgeon, which is very advantageous for the surgeon as well as the patient in long and complex interventions. The possibility of working simultaneously on two parallel consoles shortens the learning curve, reduces complication rates, and facilitates the training of surgeons (2). The advancement of robotic surgery in terms of the Da Vinci Xi permits the variable use of optics in all four trocars (paraaortic lymphadenectomy, omentectomy, or interdisciplinary surgery in the upper abdomen can be performed without re-docking) and ensures markedly greater flexibility due to the optimized geometry of the so-called patient cart. Robotic surgery has been criticized for the fact that it requires the use of larger trocars compared to conventional laparoscopy, and is therefore associated with more numerous and larger cosmetic scars; this is avoided by the smaller trocars now used in robotic surgery (3). The development of the single-site systems signifies further new options for the gynecological surgeon (Figure 2). For instance, freedom of movement is now maximized by the introduction of one or more additional working trocars (4, 5). The low level of postoperative pain appears to be another advantage. It is accompanied by a lesser need for analgesics and even shorter hospital stays compared to traditional laparoscopic surgery. One explanation could be the fact that the abdominal wall need not be used as a counter bearing. The absence of irritation and the advantage of tissue protec...

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Pregnancy outcomes following robot-assisted myomectomy

Abstract: There was no funding source for this study.

Cited by 108 publications

References 43 publications

Comparison of the Perinatal Outcomes after Laparoscopic Myomectomy versus Abdominal Myomectomy

Comparison of the Perinatal Outcomes after Laparoscopic Myomectomy versus Abdominal Myomectomy

Reproductive outcomes following robotic myomectomy

Robotic surgery in gynecology

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