Robotic myomectomy – tips & tricks

This article discusses some of the tips and tricks of performing robotic myomectomy in the areas of pre operative assessment & MRI, port placement & docking, hybrid procedure, dealing with associated sub mucous fibroids and variations in suturing techniques. Pre operative MRI of the pelvis is helps in identifying the number and location of all the fibroids. The primary port is placed in the midline. The rest of the ports are placed 10 cms apart in an inverted “W” fashion. Hybrid technique is a variation in robotic myomectomy where a conventional laparoscopic enucleation of the myoma is followed by reconstruction with the da Vinci robot. Assosciated submucous fibroids can be removed by hysteroscopy myomectomy, however large type 2-sub mucous fibroid has been removed with robotic approach. Use of unidirectional knotless barbed suture substantially facilitates closure of uterine defects during minimally invasive myomectomy and may offer additional advantages such as minimizing operative time.
Source: Apollo Medicine - Category: Journals (General) Source Type: research