Robot-assisted Laparoscopic Myomectomy Research Articles

The Relationship of Fibroid Weight to Operative Outcomes of Robot-Assisted Laparoscopic Myomectomy in a Predominantly Hispanic Population

The Relationship of Fibroid Weight to Operative Outcomes of Robot-Assisted Laparoscopic Myomectomy in a Predominantly Hispanic Population

Risk Factors for an Extended Length of Stay in Patients Undergoing Robot-Assisted Laparoscopic Myomectomy

Risk Factors for an Extended Length of Stay in Patients Undergoing Robot-Assisted Laparoscopic Myomectomy

Comparative study between robotic laparoscopic myomectomy and abdominal myomectomy

Abstract Study objective To compare short-term surgical outcomes of robotic and abdominal myomectomy and to analyze the factors affecting the short-term outcomes. Design Retrospective study of a consecutive case series at Emory Saint Joseph’s Hospital, Atlanta, USA. Subjects and method From February 2007 to June 2009, 122 patients with symptomatic leiomyomata underwent either robotic assisted laparoscopic myomectomy (RALM, n = 77) or abdominal myomectomy (AM, n = 45). The variables investigated included the type of surgery, age, BMI, gravity, parity, number of leiomyomata, diameter of largest tumor size, total operative time, estimated blood loss, and length of hospital stay. Results No significant differences were found between the two groups regarding age, gravity and parity. However, BMI, number of leiomyomata and tumor sizes were significantly higher in AM compared to RALM. The total operative time was significantly longer in RALM compared to AM. The total estimated blood loss and length of hospital stay were significantly lower in RALM compared to the AM group. The predicted odds of staying one day or less in the hospital for patients receiving RALM was 193.5 times the odds for patients receiving AM when adjusted for the number of leiomyomata and the tumor size. The probability of one day admission or less in the hospital was significantly increased for patients receiving RALM. Conclusion RALM has shorter hospital stay, less blood loss and increased operative time compared to AM, regardless of tumor size and number of tumors. Although operative time was increased with the RALM procedure, blood loss and hospital stay were integral outcomes in the study result.

Hemostatic, Reversible Clamping of the Uterine Artery during Robotic Assisted Laparoscopic Myomectomy

Hemostasis during myomectomy remains a significant challenge. The introduction of robotics has facilitated laparoscopic surgery on larger and more difficult located fibroids. Recently, improved hemostasis by reversible clamping of the uterine arteries during laparoscopic myomectomy has been reported. This video demonstrates the technique and hemostatic effect of reversible clamping of the uterine artery (RCUA) during robotic-assisted laparoscopic myomectomy.

Utilizing Firefly Technology To Minimize Blood Loss during Robotic-Assisted Laparoscopic Myomectomy

Utilizing Firefly Technology To Minimize Blood Loss during Robotic-Assisted Laparoscopic Myomectomy

Coaxial Robot-Assisted Single-Incision Laparoscopic (RA-SIL) Myomectomy and Adenomyomectomy: Technique and Outcomes

Coaxial Robot-Assisted Single-Incision Laparoscopic (RA-SIL) Myomectomy and Adenomyomectomy: Technique and Outcomes

Technique of a Reduced Port Robotic-Assisted Laparoscopic Multiple Myomectomy

Technique of a Reduced Port Robotic-Assisted Laparoscopic Multiple Myomectomy

The Feasibility of Robot-Assisted Laparoscopic Myomectomy: Compared with Standard Laparoscopic and Abdominal Myomectomy

784 THE FEASIBILITY OF ROBOT-ASSISTED LAPAROSCOPIC MYOMECTOMY: COMPARED WITH STANDARD LAPAROSCOPIC AND ABDOMINAL MYOMECTOMY Min Young Chang, MD, Sun Young Kim, MD, Min-A Kim, MD, Bo Wook Kim, MD, Hanbyoul Cho, MD, SiHyun Cho, MD, Doo Byung Chay, MD, Jae Hoon Kim, MD, Young Tae Kim, MD, Byung Seok Lee, MD, Kyung Seo, MD Department of Obstetrics and Gynecology, Gangnam Severance Hospital; Yongin Severance Hospital, Severance Hospital; Yonsei University College of Medicine, Seoul, Korea

Unexpected Diagnosis of Smooth Muscle Tumor of Uncertain Malignant Potential after Laparoscopic Uterine Morcellation

Uterine smooth muscle tumor of uncertain malignant potential (STUMP) is a rare and poorly characterized subcategory of uterine smooth muscle tumors. A recent study demonstrates a 1.2% chance of an unexpected diagnosis of leiomyoma variants or atypical and malignant smooth muscle tumors in 1,091 instances of uterine morcellation. We will discuss one patient who underwent a robotic-assisted laparoscopic myomectomy who was found to have STUMP.

Cosmetic port placement for robot-assisted laparoscopic myomectomy

The amount of visible abdominal scarring associated with the standard port placement for robot-assisted laparoscopic myomectomy (RALM) is more conspicuous than in conventional gynecologic laparoscopy. We developed a minimal access protocol for improved cosmetics in RALM. To assess the safety and efficacy of this protocol, operative outcomes were compared with those of the standard RALM.

Coaxial robot-assisted single-incision laparoscopic (RA-SIL) myomectomy and adenomyomectomy: technique and outcomes

Coaxial robot-assisted single-incision laparoscopic (RA-SIL) myomectomy and adenomyomectomy: technique and outcomes

Comparison of robot‐assisted laparoscopic myomectomy and traditional laparoscopic myomectomy

The benefit of robot-assisted laparoscopic myomectomy (RALM) over traditional laparoscopic myomectomy (TLM) remains undetermined. The aim of this study was to reveal any potential advantage of RALM over TLM. Between June 2010 and October 2011, all women presenting with symptomatic uterine myomas were enrolled in this study. Perioperative variables were compared between these two groups. The patients recruited in this study were allocated into the two groups based on their financial considerations. A total of 42 patients received RALM (n = 20) or TLM (n = 22) for symptomatic uterine myomas. The operation time was longer in the RALM group; but the total abdominal drainage amount on postoperative day 1 was significantly less in the RALM group than the TLM group. Multivariate analysis revealed that the RALM procedure (coefficient = 79.1, P < 0.001), number of myomas (coefficient = 15.4, P = 0.002), and the presence of a cervical myoma (coefficient = 54.9, P = 0.01) were independent factors affecting operation time; the maximum myoma diameter was the only factor affecting blood loss (coefficient = 113.4, P = 0.003). However, the RALM procedure was the only factor affecting the amount of abdominal drainage on postoperative day 1 (coefficient = -86.3, P = 0.006). Although RALM is a longer operation than TLM, it might result in less postoperative abdominal drainage than TLM and help alleviate short-term morbidity.

Postoperative Outcomes After Robotic Versus Abdominal Myomectomy

Differences in postoperative outcomes comparing robotic-assisted laparoscopic myomectomy (RALM) with abdominal myomectomy (AM) have rarely been reported. The objective of this study was to compare surgical, quality-of-life, and residual fibroid outcomes after RALM and AM. Consecutive patients who underwent RALM (n = 16) were compared with AM patients (n = 23) presenting with a uterine size of <20 weeks. Study patients participated in a telephone interview at 6 weeks and underwent a no-cost ultrasonographic examination at 12 weeks after surgery to obtain quality-of-life and residual fibroid outcomes. Medical records were reviewed to obtain surgical outcomes. Longer operative times (261.1 minutes vs 124.8 minutes, P < .001) and a 3-fold unfavorable difference in operative efficiency (73.7 g vs 253.0 g of specimen removed per hour, P < .05) were observed with RALM compared with AM. Patients undergoing RALM had shorter lengths of hospital stay (1.5 days vs 2.7 days, P < .001). Reduction of patient symptoms and overall satisfaction were equal. RALM patients were more likely to be back to work within 1 month (85.7% vs 45.0%, P < .05). Residual fibroid volume in the RALM group was 5 times greater than that in the AM group (17.3 cm(3) vs 3.4 cm(3), P < .05). RALM and AM were equally efficacious in improving patient symptoms. Although operative times were significantly longer with RALM, patients had a quicker recovery, demonstrated by shortened lengths of stay and less time before returning to work. However, greater residual fibroid burden was observed with RALM when measured 12 weeks after surgery.

Pregnancy outcomes following robot-assisted myomectomy

What are the characteristics of the pregnancy outcomes in women undergoing robot-assisted laparoscopic myomectomy (RALM) for symptomatic leiomyomata uteri? Despite a high prevalence of women with advanced maternal age, obesity and multiple pregnancy in our cohort, the outcomes are comparable with those reported in the literature for laparoscopic myomectomy. Reproductive outcomes after traditional laparoscopic myomectomy are well documented. However, reproductive outcomes following robotic myomectomy are not well studied. This paper describes the pregnancy outcomes for a large cohort of women after robotic myomectomy. This is a retrospective cohort of women who became pregnant after robot-assisted myomectomy at three centers. Of the 872 women who underwent robotic myomectomy during the period October 2005-November 2010, 107 subsequently conceived resulting in 127 pregnancies and 92 deliveries through 2011. Women of reproductive age with fibroids who wanted a minimally invasive treatment option and desired uterine preservation were recruited. We conducted a multicentre study with three centers, two in a private practice and one in an academic setting. Pregnancy outcomes and their relationship to myoma characteristics were analyzed. Mean ± SD age at myomectomy was 34.8 ± 4.5 years and 57.4% [95% confidence interval (CI) 48.0, 66.3] of women were overweight or obese. The mean number of myomas removed was 3.9 ± 3.2 with a mean size of 7.5 ± 3.0 cm and mean weight of 191.7 ± 144.8 g. Entry of the myoma into the endometrial cavity occurred in 20.6% (95% CI 15.0, 27.7) of patients. The mean time to conception was 12.9 ± 11.5 months. Assisted reproduction techniques were employed in 39.4% (95% CI 32.6, 46.7) of these women. Seven twin pregnancies and two triplet pregnancies occurred, for a multiple pregnancy birth rate of 9.8% (95% CI 5.0, 17.8). Spontaneous abortions occurred in 18.9% (95% CI 13.0, 26.6). Preterm delivery prior to 35 weeks of gestational age occurred in 17.4% (95% CI 10.9, 26.5). One uterine rupture (1.1%; 95% CI 0.3, 4.7) was documented. Pelvic adhesions were discovered in 11.4% (95% CI 7.0, 18.0) of patients delivered by Cesarean section. Higher preterm delivery rates were significantly associated with a greater number of myomas removed and anterior location of the largest incision (compared with all other sites) in logistic regression analyses (P = 0.01). None of the myoma characteristics were related to spontaneous abortion. Given the retrospective nature of the data collection, some pregnancies may not have been captured. In addition, owing to the high prevalence of infertility patients in this cohort, the data cannot be used to counsel women who are undergoing RALM about fertility rates after surgery. Prospective studies are needed to determine if the results shown in our cohort are generalizable to all women seeking a minimally invasive option for the conservative treatment of symptomatic fibroids with pregnancy as a desired outcome. There was no funding source for this study.

Pregnancy Outcomes Following Robot-Assisted Laparoscopic Myomectomy

Pregnancy Outcomes Following Robot-Assisted Laparoscopic Myomectomy

I246 ROBOTIC ASSISTED LAPAROSCOPIC MYOMECTOMY

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S222-S222 Invited presentations and presentations by organisations and societies I246 ROBOTIC ASSISTED LAPAROSCOPIC MYOMECTOMY C.E. Miller, C.E. MillerSearch for more papers by this author C.E. Miller, C.E. MillerSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)60276-8AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S222-S222 RelatedInformation

Comparison of robotic-assisted laparoscopic myomectomy outcomes with laparoscopic myomectomy

This study aimed at comparing short-term outcomes of patients who underwent robotic-assisted laparoscopic myomectomy and laparoscopic myomectomy. From January 2008 to August 2010, prospective data including 15 consecutive patients who underwent robotic-assisted myomectomy (RALM) with the da Vinci surgical system were recorded. These cases were compared with a retrospective cohort of 23 patients who underwent laparoscopic myomectomy (LM). Patient demographics, fibroid characteristics and peri-operative data (operative time, anesthesia time, set-up time, console time for robotic cohort, Estimated blood loss (EBL), length of hospital stay, conversion to laparotomy and operative complications were collected in both groups. Mean operative time for the robotic group was 138.73 ± 39.51 min compared with 140.57 ± 38.17 min for the laparoscopy group (p = 0.887). No significant differences were noted between RALM versus LM for hospital stay (1.67 ± 0.58 vs. 1.87 ± 0.67 days, p = 0.369) and EBL (101.33 ± 39.84 vs. 119.78 ± 43.70 ml, p = 0.549). The numbers, size and location of myomas removed for two groups were similar. None of the cases in both groups required conversion to laparotomy. There were no significant intra-operative and post-operative complications in either group. RALM appears to provide the same surgical outcomes when compared with traditional laparoscopic myomectomy.

Robot-Assisted Laparoscopic Myomectomy Compared With Standard Laparoscopic Myomectomy

To compare surgical outcomes of laparoscopic myomectomy and robot-assisted laparoscopic myomectomy. Retrospective cohort study of 115 consecutive laparoscopic myomectomy and 174 consecutive robot-assisted laparoscopic myomectomy performed at Brigham and Women's Hospital over a period of 31 months. Uterine incisions were closed in multiple layers (running barbed suture was used for most cases in the laparoscopic myomectomy group). Surgical outcomes measured included operative time, estimated intraoperative blood loss, length of hospital stay, and perioperative complications. Odds ratios and 95% confidence intervals were calculated from multivariable logistic regression models; adjusted geometric means were estimated from linear regression models on logged outcomes because of skewed distributions. Surgical groups were similar in age, body mass index, and leiomyoma characteristics. Robot-assisted laparoscopic myomectomy had significantly longer operative time than laparoscopic myomectomy (adjusted geometric mean of 195.1 compared with 118.3 minutes, P<.001) and higher estimated blood loss (adjusted geometric mean of 110.0 compared with 85.9 mL, P=.04), but postoperative complications were similar. Robot-assisted laparoscopic myomectomy and laparoscopic myomectomy have similar operative outcomes in a high-volume surgical practice. Operative time and intraoperative estimated blood loss were significantly greater in the robot-assisted laparoscopic myomectomy group, but the level of statistical significance for intraoperative estimated blood loss was marginal and the clinical significance was undetermined. Use of barbed suture in the laparoscopic myomectomy group may account for these differences. II.

Fertility and endocrine outcome after robot-assisted laparoscopic myomectomy (RALM)

Introduction: Laparoscopic myomectomy has recently gained wide acceptance but this procedure remains technically highly demanding and concerns have been raised about the increased blood loss and an higher risk of postoperative uterine rupture of the pregnant uterus. Objective: The aim of the present study is to evaluate the fertility and endocrine outcome in women underwent robot-assisted laparoscopic myomectomy (RALM). Methods: Data from 48 RALM performed in our department between the years 2007 and 2011 have been collected. Conception rate, abortion rate, incidence of feto-maternal morbidity or severe pregnancy and labor-related complications were reported; FSH and AMH levels and ultrasound valuation of AFC has been made before and 6 months after operation. Number of cesarean sections and vaginal deliveries were described. Results: The average age of the patients was 35 years and median Body Mass Index was 23 kg/m2 (range 18–35 kg/m2). Seven women (13%) became pregnant after RALM with eight pregnancies. One pregnancy is actually on going; there were six deliveries with caesarian section and one spontaneous delivery. No spontaneous abortions. No uterine ruptures occurred. No significant modification of ovarian function was found after myomectomy. Conclusion: RALM seems to have a favorable impact on the reproductive outcome of young patients with no impact on the ovarian function.

La myomectomie par cœlioscopie avec assistance robotique : comparaison avec la laparotomie

To compare morbidity of robot-assisted laparoscopic myomectomy versus those performed by laparotomy. It reports a monocentric retrospective case matched analysis enrolling 22 patients (six laparotomic and 16 robot-assisted laparoscopic myomectomies), needing a surgical treatment for at least one myoma oversizing 6cm. Both patient groups were comparable regarding their age, their weight and myoma's size. There were more complications in the laparotomy group in comparison with the robotic group (66.7%, versus 0%; P=0.002). Average intraoperative blood losses were respectively 397±377mL versus 387±349mL (P=0.71) and length of stay 7.2±0.8 days versus 3.9±2.8 days (P<0.001). None of the robot-assisted laparoscopic myomectomy needed any conversion to laparotomy. Robot-assisted laparoscopic myomectomy seems to be feasible for heavy fibroids, with a lower morbidity in comparison with laparotomy. These results must be confirmed by several wider prospective studies.