Safety and economical innovations regarding surgical treatment of fibroids

Alkatout, İbrahim; Mettler, Liselotte; Maass, Nicolaì; Eckmann-Scholz, Christel; Elessawy, Mohamed; Anapolski, Michael

doi:10.1080/13645706.2016.1190380

Cited by 18 publications

(17 citation statements)

References 50 publications

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“…Uterine leiomyomas are benign tumors which arise in the uterine myometrial smooth muscle and are clinically apparent in about 20% to 25% of women in reproductive age 6,10,11 . Surgical intervention may be indicated in women with large, symptomatic uterine leiomyomas 7,12 .…”

Section: Discussionmentioning

confidence: 99%

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Intra and Postoperative Morbidity Associated with Myomectomy

Bushaqer¹,

Jama²,

Turki³

2016

BMB

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Myomectomy as an organ-preserving procedure has become an established alternative to hysterectomy 1-3. An increasing number of women in their fourth to fifth decade request conservative surgery to preserve their reproductive potential 2,3. New advances in assisted reproductive techniques permit women in later reproductive years to bear a child if the uterus is still intact. Submucous and intramural myoma decreases fertility and its removal is beneficial and necessary when the myoma is

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Section: Discussionmentioning

confidence: 99%

“…A current management strategy involves surgical intervention depending on the patient's age, the desire for fertility preservation or avoidance of radical surgery, such as hysterectomy 1,5,6 . Myomectomy could be performed abdominally, laparoscopically or by robotic surgeries 1,4,7 .…”

Section: Bahrain Med Bull 2016; 38(4):204 -207mentioning

confidence: 99%

Intra and Postoperative Morbidity Associated with Myomectomy

Bushaqer¹,

Jama²,

Turki³

2016

BMB

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“…HM is considered the gold standard and first-line surgical therapy for most submucosal fibroids. 10,13,29,30 Few data and guidelines are available regarding the size and other characteristics of fibroids that prevent a hysteroscopic (HSC) approach. The American Association of Gynecologic Laparoscopists (AAGL) note that submucosal fibroids up to 4 to 5 cm can be removed via HSC by experienced surgeons.…”

Section: Hysteroscopic Myomectomy Indications and Patient Selectionmentioning

confidence: 99%

Minimally Invasive Approaches to the Surgical Management of Fibroids

Wang

2017

Semin Reprod Med

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Uterine fibroids, as the most common benign neoplasm of the female reproductive tract, can significantly impact a woman's quality of life through abnormal uterine bleeding, infertility, and bulk symptoms. When medical therapy for symptomatic fibroids fails, surgery is the recommended treatment. While a hysterectomy through laparotomy was historically the first-line surgical approach for fibroids, multiple minimally invasive and uterine-sparing techniques are now available. An evidence-based literature review of the following minimally invasive approaches is detailed in this article: hysteroscopic myomectomy, laparoscopic and robotically assisted myomectomy, laparoscopic and robotically assisted hysterectomy, and ultrasound-guided radiofrequency ablation. For each approach, this review discusses the indications, patient selection, adjunct preoperative treatment modalities, instrumentation, techniques, and pertinent intraoperative considerations such as fluid management, interventions to reduce blood loss, antiadhesion barriers, and tissue extraction. Perioperative benefits, long-term outcomes including recurrence and fertility, and comparisons of outcomes among the various approaches are outlined as well. With continued technological advancements and surgical innovations, minimally invasive techniques will become the mainstay of surgical management for symptomatic fibroids to provide high-quality patient-centered care.

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“…The use of disposable laparoscopic instruments, for instance, was not taken into account (50). Statistical projections about the required number of robotic interventions per year in order to achieve profitability range between 165 and 400 operations (49,51).…”

Section: Cost Efficiency Of Robotic Surgerymentioning

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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Safety and economical innovations regarding surgical treatment of fibroids

Cited by 18 publications

References 50 publications

Intra and Postoperative Morbidity Associated with Myomectomy

Intra and Postoperative Morbidity Associated with Myomectomy

Minimally Invasive Approaches to the Surgical Management of Fibroids

Robotic surgery in gynecology

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