Surgical techniques: robot-assisted laparoscopic myomectomy with the da Vinci(®) surgical system

Myomectomy remains the surgical option of choice for women with symptomatic leiomyomata who desire uterine conservation or in particular future fertility. The ability to enucleate leiomyomata and repair the uterus with a multilayer-sutured closure is both crucial and technically challenging. Advanced gynecologic pathology and the surgical limitations of conventional laparoscopy have often been cited as impediments to not only these critical steps but also to converting a myomectomy from a procedure predominantly performed by laparotomy to one accomplished by laparoscopy. Recently, the use of robotic technology as a means to facilitate the laparoscopic completion of a myomectomy was introduced. Advantages to this approach have been the improved dexterity and precision of the instruments coupled with three-dimensional imaging. Published preliminary data have shown the feasibility and safety to this approach. This paper will outline a safe and efficient surgical technique for completing a robot-assisted laparoscopic myomectomy with the da Vinci(®) surgical system.