How I do … A robotic-assisted laparoscopic myomectomy

Uterine fibroids are the most common benign uterine tumors and may require surgical management in symptomatic patients desiring uterine preservation. Robot-assisted laparoscopic myomectomy has emerged as a minimally invasive alternative to open surgery, offering reduced intraoperative blood loss and faster postoperative recovery. We describe our surgical technique as performed at Bichat-Claude Bernard University Hospital (AP-HP), with particular emphasis on intraoperative hemostatic strategies: uterine artery clamping with Bulldog MicroClamp clips, pericervical tourniquet using a Foley catheter, and multilayer myometrial closure with V-Loc barbed sutures. Preoperative prehabilitation, including GnRH agonist therapy and iron supplementation, is considered to optimize hemoglobin levels prior to surgery. Trocar placement, robotic docking configuration, and contained morcellation technique are also detailed. This standardized approach seems to yield excellent functional outcomes while minimizing hemorrhagic complications.