Munoz, Ma. Steffi Lindsay M.

BSN IV – 10 Group A

JOURNAL: LATEST TREND IN MYOMECTOMY

Robotic Myomectomy for Treating Uterine Fibroids

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

Robotic Myomectomy is a minimally invasive procedure that uses laparoscopic myomectomy through
small :"keywhole" incisions and reduces patient's recovery time.

Myomectomy is the only surgical treatment of myomas that preserves fertility. The fibroids are removed surgically
from the uterus. This is the best method for women who want to become pregnant.

Symptoms such as pressure and heavy bleeding are eliminated or reduced after the fibroids are removed.

Surgery Overview

The robot-assisted myomectomy combines the thoroughness of the traditional open myomectomy with a
minimally invasive procedure, through tiny 1-2 cm incisions in the uterus, and is effective for large tumors.

During Robotic myomectomy, the surgeon sits at a special console with hand and foot controls that move the
robotic arms during the operation. The arms of the robot are extremely nimble and are manipulated by the
surgeon using joystick-like controls. The robot also has a camera that gives the surgeon a magnified 3-D view,
called telepresence surgery. Very small blood vessels and nerves can be seen clearly and can be spared. The hand
movements of the surgeon are duplicated in the patient by the robot, but on a much smaller scale. The robot
allows cutting away tissue, cauterizing blood vessels, and suturing, using needles held by pincer like "needle
drivers." The robot's wrist can turn nearly 360 degrees, allowing great flexibility. The robot also eliminates any
tremor in a surgeon's hands, and for delicate work, "motion scaling" software reduces a surgeon's actual hand
movements to much smaller, finer instrument movements. Robot assisted surgery allows the surgeon greater
dexterity than traditional laparoscopy. The surgeon performs the surgery - not the robot. The robot cannot make
decisions on its own.

Although some women with uterine fibroid tumors have to have a hysterectomy, a robotic myomectomy is
providing other women an opportunity to retain their uterus and subsequently, retain their fertility. Laparoscopic
myomectomies often take longer than open abdominal myomectomies, and up to 28% are converted during
surgery to an open abdominal incision if the myomas are too large and/or there are many myomas.
The robot assisted procedure is performed on an outpatient basis and women can return to work in about a week.
There are many advantages to robotic myomectomy over regular laparoscopic myomectomy: a quicker recovery
time, less pain and discomfort, less scaring, less trauma, fewer complications, less blood loss, a decreased need for
blood transfusions, reduced risk of infection, shorter hospital stays and faster recoveries. The recovery time is very
minimal because there is no incision or hysterectomy.

Risk factors for complications during robot-assisted laparoscopic procedures include: pre-existing heart or lung
condition, Obesity, Diabetes, Excessive alcohol intake, Previous abdominal or pelvic surgery. Possible complications
include recurrence of fibroids, perforation of the uterus or bowel during surgery, weakened uterine wall, pelvic
adhesions that can cause pain or bowel obstruction, infertility and the need for special precautions in pregnancy.

REACTION:

For women who are seeking the most effective but least invasive treatment for uterine
fibroids a Robotic Myomectomy may be the best treatment option available. This uterine
preserving procedure performed with the assistance of the da Vinci surgical system allows the
surgeon to perform this delicate procedure with unsurpassed benefits that both surgeon and
patient can appreciate. This surgical system provides the surgeon an alternative to both
traditional open myomectomy and conventional laparoscopic myomectomy thus allowing the
surgeon to perform surgery through smaller incisions which dramatically enhances visualization
and precision in the surgical field. With this minimal incision, this procedure can be most
beneficial to those women who want opportunity for future pregnancy. Other benefits include
reduced hospital stay, minimal scarring, less blood loss and faster return to normal daily
activities therefore improving the quality of life of the patients.