Abstract
Robot-assisted laparoscopic myomectomy (RALM) has broadened the indications even in complex myomas. However, the high cost of RALM remains the main disadvantage. Therefore, a surgical technique that can reduce the cost of RALM and still has the advantages of robotic surgery is required. We propose a “locking suture on myoma (LSOM)” technique and compared the operative and perioperative outcomes of patients who underwent RALM with or without the LSOM technique. We included 337 patients who underwent RALM with (n = 160) or without (n = 177) the LSOM technique between March 2019 and August 2020. The LSOM group had low parity and gravidity, with a low rate of Cesarean sections. Myoma type was not different between the groups; however, patients in the LSOM group had larger, heavier, and higher number of myomas, although fewer patients had multiple myomas and were discharged earlier. Total operating time, estimated blood loss, pre- and postoperative hemoglobin levels, transfusion rate, and postoperative fever were not different between the two groups. In conclusion, the LSOM technique may be a viable surgical option for myomas, as it can reduce the cost of RALM by obviating the need for robotic Tenaculum forceps.
Highlights
Uterine myoma is a common benign gynecologic tumor in reproductive-aged women, and myomectomy is the standard fertility-preserving surgical option [1,2]
We aimed to evaluate the locking suture on myoma (LSOM) technique in terms of estimated blood loss (EBL) and operating time (OT)
There were no factors associated with EBL, including LSOM (Table 3)
Summary
Uterine myoma is a common benign gynecologic tumor in reproductive-aged women, and myomectomy is the standard fertility-preserving surgical option [1,2]. The use of minimally invasive surgery, including laparoscopic myomectomy and robot-assisted laparoscopic myomectomy (RALM), is growing rapidly [3,4,5,6]. Laparoscopic myomectomy has a limitation in multiple-layered intracorporeal myometrial suturing that is often challenging even for experienced laparoscopic surgeons. Robotic surgical systems can help overcome this obstacle by EndoWrist technology (Intuitive Surgical, Sunnyvale, CA, USA), which allows the articulation of instruments by up to 540◦ and 45◦ for multi-port and single-site robotic instruments, respectively. RALM has an advantage for easier multiple intracorporeal suturing than laparoscopic myomectomy. The high cost of RALM is a major disadvantage [4,5,6,7,8]. Varghese et al [9]
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