Ultrasound-guided robotic myomectomy using a drop-in probe

Area of Science:

• Minimally Invasive Surgery
• Surgical Technology
• Gynecologic Oncology

Background:

• Robot-assisted myomectomy provides minimally invasive benefits but lacks tactile feedback, complicating intramural fibroid identification.
• Accurate fibroid localization is crucial, especially in fertility-preserving procedures and cases with multiple myomas.
• Intraoperative ultrasound (IOUS) aids laparoscopic myomectomy, but its use in robot-assisted myomectomy is not well-documented.

Purpose of the Study:

• To present a technique for ultrasound-guided robot-assisted myomectomy.
• To demonstrate the utility of a robotic drop-in ultrasound probe for enhanced fibroid detection.
• To improve the identification of occult intramural fibroids during robot-assisted myomectomy.

Main Methods:

• A novel technique using a robotic drop-in ultrasound probe during robot-assisted myomectomy was developed.
• The probe was applied directly to the uterine surface post-enucleation of visible fibroids.
• Ultrasound images were displayed in real-time on the robotic console, correlated with the operative field.

Main Results:

• The technique allows systematic scanning of the myometrium for fibroid detection.
• Real-time correlation of ultrasound imaging with surgical anatomy facilitates identification of occult intramural fibroids.
• Ultrasound guidance supports precise fibroid enucleation, improving surgical accuracy.

Conclusions:

• Ultrasound-guided robot-assisted myomectomy with a robotic probe is a feasible technique.
• This approach enhances the detection of intramural fibroids, particularly occult ones.
• The method supports improved outcomes in fertility-preserving and complex myomectomy cases.