Suturing Techniques during Robotic-Assisted Myomectomy

Abstract

Study Objective To help novice surgeons master robotic suturing techniques using side-by-side views of the surgical instruments and field as well as the surgeon's hands at the console during robotic-assisted myomectomy. Design Compilation of recorded video segments showing the suturing of various myometrial defects with simultaneous views of the surgeon's hands during robotic-assisted myomectomy. Setting A tertiary care hospital. Patients or Participants A total of four patients were selected to demonstrate different suture techniques after removal of leiomyoma of different sizes and locations within the uterus. Interventions Deep myometrial defects are standardly closed in three layers starting with a deep running stitch, followed by an imbricating layer, and lastly with a baseball stitch closure of the uterine serosa utilizing a unidirectional barbed suture. We demonstrate different tips and tricks for proper ergonomic placement of the hands at the console, needle handling and camera angling that can be employed, depending on the location and orientation of the hysterotomy site. The intra-abdominal surgical views are shown alongside the view of the surgeon's hands at the console. Measurements and Main Results N/A Conclusion By offering a side-by-side view of the surgical instruments and the hand orientation of the surgeon at the console, it provides an additional perspective for a surgical learner that is otherwise not achievable in the intraoperative setting for robotic surgeries. We hope that this video can serve as a helpful resource to surgeons, instructors, and trainees for suturing techniques during robotic-assisted myomectomies.