A Technique for Vascular Control During Robotic-assisted Laparoscopic Myomectomy

Area of Science:

• Minimally Invasive Surgery
• Gynecologic Oncology
• Surgical Techniques

Background:

• Myomectomy is crucial for fertility preservation in women with symptomatic leiomyomas.
• Robotic-assisted myomectomy offers potential benefits but still carries risks of blood loss and transfusion.
• Managing blood loss is a key challenge in myomectomy procedures.

Purpose of the Study:

• To demonstrate a unique method for superior vascular control during robotic myomectomy.
• To detail a technique for minimizing blood loss in robotic myomectomy.
• To present a case of robotic myomectomy utilizing enhanced vascular control in a Jehovah's Witness patient.

Main Methods:

• A video demonstrating skeletonization of uterine vessels and temporary uterine artery occlusion.
• Utilized vascular clips and bulldog clamps for transient occlusion of uterine and utero-ovarian vessels.
• Involved subserosal injection of dilute vasopressin and creation of a peritoneal window for vessel access.

Main Results:

• The described technique successfully maximized vascular control during robotic myomectomy.
• The method aimed to minimize intraoperative blood loss.
• The procedure was successfully performed on a Jehovah's Witness patient, highlighting its applicability in specific populations.

Conclusions:

• Temporary occlusion of uterine vessels is an effective strategy for improved vascular control in robotic myomectomy.
• This technique can be considered by experienced surgeons for selected patients to reduce blood loss.
• The approach may potentially decrease the need for blood transfusions during myomectomy.