Abstract
BackgroundThis study aimed to evaluate the compatibility of robotic single-site (RSS) myomectomy in comparison with the conventional robotic multi-port (RMP) myomectomy to achieve successful surgical outcomes with reliability and reproducibility.MethodsThis retrospective case–control study was performed on 236 robotic myomectomies at a university medical center. After 1:1 propensity score matching for the total myoma number, total myoma diameter, and patient age, 90 patients in each group (RSS: n = 90; RMP: n = 90) were evaluated. Patient demographics, preoperative parameters, intraoperative characteristics, and postoperative outcome measures were analyzed.ResultsThe body mass index, parity, preoperative hemoglobin levels, mean maximal myoma diameter, and anatomical type of myoma showed no mean differences between RSS and RMP myomectomies. The RSS group was younger, had lesser number of myomas removed, and had a smaller sum of the maximal diameter of total myomas removed than the RMP group. After propensity score matching, the total operative time (RSS: 150.9 ± 57.1 min vs. RMP: 170 ± 74.5 min, p = 0.0296) was significantly shorter in the RSS group. The RSS group tended to have a longer docking time (RSS: 9.8 ± 6.5 min vs. RMP: 8 ± 6.2 min, p = 0.0527), shorter console time (RSS: 111.1 ± 52.3 min vs. RMP: 125.8 ± 65.1 min, p = 0.0665), and shorter time required for in-bag morcellation (RSS: 30.1 ± 17.2 min vs. RMP: 36.2 ± 25.7 min, p = 0.0684). The visual analog scale pain score 1 day postoperatively was significantly lower in the RSS group (RSS: 2.4 ± 0.8 days vs. RMP: 2.7 ± 0.8 days, p = 0.0149), with similar consumption of analgesic drugs. The rate of transfusion, estimated blood loss during the operation, and length of hospital stay were not different between the two modalities. No other noticeable complications were observed in either group.ConclusionsDa Vinci RSS myomectomy is a compatible option with regard to reproducibility and safety, without significantly compromising the number and sum of the maximal diameter of myomas removed. The advantage of shorter total operative time and less pain with the same amount of analgesic drugs in RSS myomectomy will contribute to improving patient satisfaction.
Highlights
This study aimed to evaluate the compatibility of robotic single-site (RSS) myomectomy in comparison with the conventional robotic multi-port (RMP) myomectomy to achieve successful surgical outcomes with reliability and reproducibility
By performing a comparative analysis between the Da Vinci conventional RMP and RSS myomectomies performed at a university medical center, we aim to demonstrate whether the RSS procedure is compatible with regard to the number, size, and location of the resected myomas, as well as the technical reproducibility, safety, and surgical outcomes of the procedure
No significant difference was observed in the proportion of obese patients with body mass index (BMI) more than 25 kg/m2, parity, preoperative hemoglobin levels, maximal diameter of myomas, and location of myomas according to the Federation of Gynecology and Obstetrics (FIGO) staging between the RSS and RMP myomectomy groups (Table 1)
Summary
This study aimed to evaluate the compatibility of robotic single-site (RSS) myomectomy in comparison with the conventional robotic multi-port (RMP) myomectomy to achieve successful surgical outcomes with reliability and reproducibility. When the lowest number of ports is desired, single-incision laparoscopy-guided myomectomy could be performed; the added limitations of the degree of freedom for surgical tool manipulation have hindered its widespread application [6]. The demand for using the lowest number of ports to induce compatible surgical outcomes has always been sought out in gynecologic surgery due to poorer cosmesis, higher costs, and the complexity of robotic multiport (RMP) surgery compared to traditional single-port incision laparoscopic surgery [9, 10]
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