Tips and Details for Successful Robotic Myomectomy: Single-Center Experience with the First 125 Cases

Abstract

With the continuous development of minimally invasive and precise surgical techniques, laparoscopic myomectomy has become a mainstream surgical method due to its aesthetic outcomes and rapid postoperative recovery. However, during laparoscopic myomectomy, clinicians often encounter unfavorable factors, such as limited vision, inaccurate suturing, difficulty in removing tumors, and susceptibility to fatigue in the operating position. In recent years, robot-assisted surgery has been widely used in gynecology. The advantages of this technique, such as a three-dimensional surgical view, reducing the surgeon’s tremor, and the seven degrees of freedom of the robotic arms, compensate for the defects in laparoscopic surgery. The Department of Gynecology in our hospital has accumulated a wealth of experience since robot-assisted surgery was first carried out in 2017. In this article, the surgical skills of the robotic myomectomy process are described in detail.

Cervical Fibroids: the vaginal intracapsular myomectomy with classification by the fibroids' origin, growth directions and localizations

“…Tab.S.3), cohort laparoscopic studies [23,33,36,38,39,41], and in all Chinese projects (p<0.001) compared to the current study parameter (Suppl.Tab.S.6). There were substantially longer the median values with lower-upper ranges in other studies [24,34,35,40].…”

“…As shown in Tab. 1, the cervical myomectomies were performed via laparoscopic, open, and vaginal approaches, respectively, in 198 (71.48%), 41 (14.8%), and 38 (13.72%) patients in English studies [23,24,26,[33][34][35][36][37][38][39][40][41], including case report studies CR#1 -CR#5 represented in (Suppl.…”

“…1). Other medications, such as terlipressin [24] and epinephrine, were also applied in Chinese studies (Suppl. Tab.S6).…”

“…Tab.S.4) [23,[39][40][41]. Some surgeons used the 'water caution method' to reduce blood loss during surgery [24] or a local hemostatic barrier to fill the fibroid bed to prevent bleeding after surgery [44] and in case report study CR#3 (Suppl. Tab.…”

“…Chang et al [23] described 28 (7.68%) CFs cases among 367 patients who underwent laparoscopic myomectomies at the National Taiwan university hospital. Analogously, Dou & Zhang [24] reported about 18 (7.66%) cases of CFs among 235 patients who underwent laparoscopic and robot-assisted myomectomy in the medical university hospital in Shenyang, China. Ingala et al [25] observed 26 (4.04%) patients with CFs among 644 myomectomy and hysterectomy cases in Congolese women treated in three capital city medical institutions.…”