How I do … A robotic-assisted laparoscopic myomectomy

Area of Science:

• Gynecology
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Uterine fibroids are common benign tumors requiring surgical intervention in symptomatic women.
• Robot-assisted myomectomy presents a minimally invasive alternative to open surgery for uterine preservation.
• This approach aims to reduce blood loss and expedite postoperative recovery.

Purpose of the Study:

• To describe a standardized robot-assisted laparoscopic myomectomy technique.
• To highlight intraoperative hemostatic strategies for minimizing blood loss.
• To detail preoperative optimization and surgical steps for effective uterine fibroid management.

Main Methods:

• Uterine artery clamping using Bulldog MicroClamp clips.
• Pericervical tourniquet application with a Foley catheter.
• Multilayered myometrial closure with V-Loc barbed sutures.
• Preoperative GnRH agonist therapy and iron supplementation.
• Detailed trocar placement, robotic docking, and contained morcellation.

Main Results:

• The described standardized approach aims for excellent functional outcomes.
• Minimization of hemorrhagic complications is a key objective.
• The technique focuses on preserving uterine function while managing fibroids.

Conclusions:

• Robot-assisted myomectomy with specific hemostatic techniques offers a safe and effective surgical option.
• Preoperative optimization and meticulous surgical technique contribute to favorable patient outcomes.
• This approach provides a minimally invasive solution for symptomatic uterine fibroids, prioritizing uterine preservation.