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Robot-assisted laparoscopic myomectomy; a feasible technique for
removal of unfavorably localized myomas
OBJECTIVE: To describe the feasibility of
robot-assisted laparoscopic myomectomy for unfavorably localized myomas
using the da Vinci surgical system. DESIGN: Prospective observational.
SETTING: University hospital. METHOD: Between April 2006 and March 2008, a
robot-assisted laparoscopic myomectomy was performed on 13 women selected
for having deep intramural myomas with probable impact on fertility and/or
later pregnancy. The alternative surgical approach for all 13 was
myomectomy via laparotomy. A transvaginal ultrasonography (TVUS) mapping
of the myomas was performed to enable an optimal approach during surgery.
Using a prospective protocol, relevant times at the operating theater as
well as postoperative and follow-up data, were obtained. RESULTS: Median
time for surgery was 132 minutes (range 94-209 minutes). Median blood loss
was 50 ml (range 25-200 ml). No significant complication occurred during
or after surgery. Median postoperative hospital stay was one day (range
1-3 days). At follow-up, including TVUS, no unexpected residual myomas
larger than 5 mm were identified. Of eight women with an active wish for
conception, six have become pregnant a median time of 15 months after
surgery. All additional symptoms associated with the myomas were
alleviated. CONCLUSION: Robot-assisted laparoscopic myomectomy is a
feasible technique for removal of deep intramural myomas unfavorably
localized for traditional laparoscopy. The properties of the da Vinci
robot facilitate dissection and suturing comprising the major surgical
parts of myomectomy.
PubMed |
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