It is advantageous to perform surgery in the least invasive way possible while still getting optimal results.  Although I prefer to do surgery through a laparoscope rather than a larger incision, I have felt limited by the lack of wrist-like movements of the instruments and felt that deeper myomas (that couldn’t be removed by a hysteroscope) were better removed through a regular incision. 

The da Vinci surgical robot is a major advance in the ability to precisely operate through small incisions.  The surgeon sits at a console (see photo) and sees through a 3-dimensional videocamera. 

The hand movements in the surgeon are duplicated by the robot in the patient.  Most importantly, the instruments duplicate the wrist movements of the surgeon, allowing the instruments to change angles to allow precise suturing.  (See the split photo of the robot being used for heart surgery.) 

Here are photos of an actual robotic myomectomy in which I removed 5 fibroids:

1.  An incision is being made with the da Vinci robot through the myometrium (muscle of the uterus) down to the fibroid.

 2.  The fibroid is grasped and dissected away from the surrounding myometrium.

 3.  The fibroid is almost free.  Another small fibroid, which will also be removed, is seen at the bottom right. 

 4.  The area where the myoma was is being sutured in layers. 

The da Vinci does not eliminate the need for abdominal myomectomy.  When there are very large myomas (just how large depends on many things) and many myomas an abdominal myomectomy may be preferable.

Copyright © 2006:  Paul Indman, M.D.
15195 National Ave., Suite 201
Los Gatos, CA  95032
Phone:  (408) 358-2788
Email address:  indman@egyn.com

da Vinci website

Reference:  Surgical techniques: Robot-assisted laparoscopic myomectomy with the da Vinci surgical system (641KB PDF)

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