7989 Cannonball Fibroid Robotic Myomectomy with Specimen Extraction Using Excite Technique

Abstract

<h3>Study Objective</h3> Demonstrate a safe surgical technique used for robotic myomectomy of a large "cannonball" fibroid with specimen removal through umbilical incision, with incision retractor and protected by a contained extraction system, using Extracorporeal C-Incision Tissue Extraction (ExCITE) technique. <h3>Design</h3> Case report illustrated with a video. <h3>Setting</h3> Patient is placed in semi-gynecological position. <h3>Patients or Participants</h3> 40-year-old woman reports pelvic pain, increased abdominal volume and polyuria. Nulligest patient with reproductive desire, no previous illnesses. Physical examination revealed a palpable globose mass 2 cm under the umbilical scar. MRI showed a voluminous and globose uterus of 920 cc, due to a "cannonball" FIGO 5 fundic myoma measuring 14.3 cm. <h3>Interventions</h3> 8 mm incision was performed in the umbilical scar for endoscope robotic trocar. Other two 8mm incisions was performed in each flank to other robotic trocars. And one 5mm incision was performed in right hypochondrium for laparoscopic assistance. Inspection shows a voluminous uterus with a large fundic fibroid measuring about 14 cm. Wedge hysterotomy was performed for fibroid enucleation, with subsequent hysterorrhaphy. Then, specimen was removed through the umbilical incision, protected by a contained extraction system and using a wound retractor, under ExCITE technique. <h3>Measurements and Main Results</h3> We obtained efficient specimen extraction with safe and agile tissue fragmentation, maintaining aesthetic benefit for the patient. Patient was discharged in the second postoperative day, showing great evolution. <h3>Conclusion</h3> Extraction of big fibroids is often challenging for the minimally invasive gynecological surgeon. Using ExCITE technique inside a specimen containment bag with sharp instrumentation protector, it is possible to perform safe, agile and reproducible extraction technique, with efficient removal of tissue, avoiding the use of eletromechanic morcellator and the opening of vaginal dome.