Obstet Gynecol Sci.  2019 Jan;62(1):56-64. 10.5468/ogs.2019.62.1.56.

Robotic-assisted laparoscopic myomectomy: the feasibility in single-site system

• Choi SH
• Hong S
• Kim M
• Bae HS
• Kim MK
• Kim ML
• Jung YW
• Yun BS
• Seong SJ

• KMID: 2430930
• DOI: http://doi.org/10.5468/ogs.2019.62.1.56

Abstract

OBJECTIVE
To evaluate the feasibility of robotic single-site myomectomy (RSSM).
METHODS
Medical records of 355 consecutive women who underwent robotic-assisted laparoscopic myomectomy were retrospectively reviewed. Clinical characteristics were compared between multi-site and single-site systems. After 1:1 propensity score matching for the total myoma number, largest myoma size, and total tumor weight (105 women in each group), surgical outcomes were also compared between the 2 systems.
RESULTS
A total of 105 (29.6%) and 250 (70.4%) women underwent RSSM and robotic multi-site myomectomy (RMSM), respectively. RSSM was more commonly performed in women with lower body mass index (21.6 vs. 22.5 kg/m2, P=0.014), without peritoneal adhesions (7.6% vs. 24.8%, P < 0.001), and less (2.6 vs. 4.6, P < 0.001) and smaller (6.3 vs. 7.7 cm, P < 0.001) myomas compared to RMSM. After propensity score matching, the largest myoma size (P=0.143), total myoma number (P=0.671), and tumor weight (P=0.510) were not significantly different between the 2 groups. Although the docking time was significantly longer in the RSSM group (5.1 vs. 3.8 minutes, P=0.005), total operation time was similar between RSSM and RMSM groups (145.9 vs. 147.3 minutes, P=0.856). Additionally, hemoglobin decrement was lower in the RSSM group than in the RMSM group (1.4 vs. 1.8 g/dL, P=0.009). No surgical complication was observed after RSSM, while 1 ileus and 2 febrile complications occurred in women that underwent RMSM (0% vs. 2.9%, P=0.246).
CONCLUSION
Although RMSM is preferred for women with multiple large myomas in real clinical practice, RSSM seems to be a feasible surgical method for less complicated cases, and is associated with minimal surgical morbidity.

Keyword

Myomectomy; Robotic surgical procedures; Feasibility studies

MeSH Terms

Body Mass Index
Feasibility Studies
Female
Humans
Ileus
Medical Records
Methods
Myoma
Propensity Score
Retrospective Studies
Robotic Surgical Procedures
Tumor Burden

Figure

• 

  Fig. 1 Flow diagram of study population. RMSM, robotic multi-site myomectomy; RSSM, robotic single-site myomectomy.

Reference

1. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003; 188:100–107.

2. Mais V, Ajossa S, Guerriero S, Mascia M, Solla E, Melis GB. Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol. 1996; 174:654–658.

3. Seracchioli R, Rossi S, Govoni F, Rossi E, Venturoli S, Bulletti C, et al. Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod. 2000; 15:2663–2668.

4. Borgfeldt C, Andolf E. Transvaginal ultrasonographic findings in the uterus and the endometrium: low prevalence of leiomyoma in a random sample of women age 25-40 years. Acta Obstet Gynecol Scand. 2000; 79:202–207.

5. Marsh EE, Ekpo GE, Cardozo ER, Brocks M, Dune T, Cohen LS. Racial differences in fibroid prevalence and ultrasound findings in asymptomatic young women (18–30 years old): a pilot study. Fertil Steril. 2013; 99:1951–1957.

6. Lee HJ, Kim JY, Kim SK, Lee JR, Suh CS, Kim SH. Learning curve analysis and surgical outcomes of single-port laparoscopic myomectomy. J Minim Invasive Gynecol. 2015; 22:607–611.

7. Murji A, Patel VI, Leyland N, Choi M. Single-incision laparoscopy in gynecologic surgery: a systematic review and meta-analysis. Obstet Gynecol. 2013; 121:819–828.

8. Rao PP, Rao PP, Bhagwat S. Single-incision laparoscopic surgery - current status and controversies. J Minim Access Surg. 2011; 7:6–16.

9. Weibl P, Klingler HC, Klatte T, Remzi M. Current limitations and perspectives in single port surgery: pros and cons laparo-endoscopic single-site surgery (LESS) for renal surgery. Diagn Ther Endosc. 2010; 2010:759431.

10. Vizza E, Corrado G, Mancini E, Baiocco E, Patrizi L, Fabrizi L, et al. Robotic single-site hysterectomy in low risk endometrial cancer: a pilot study. Ann Surg Oncol. 2013; 20:2759–2764.

11. Escobar PF, Fader AN, Paraiso MF, Kaouk JH, Falcone T. Robotic-assisted laparoendoscopic single-site surgery in gynecology: initial report and technique. J Minim Invasive Gynecol. 2009; 16:589–591.

12. Scheib SA, Fader AN. Gynecologic robotic laparoendoscopic single-site surgery: prospective analysis of feasibility, safety, and technique. Am J Obstet Gynecol. 2015; 212:179.e1–179.e8.

13. Cela V, Freschi L, Simi G, Ruggiero M, Tana R, Pluchino N. Robotic single-site hysterectomy: feasibility, learning curve and surgical outcome. Surg Endosc. 2013; 27:2638–2643.

14. Gargiulo AR, Lewis EI, Kaser DJ, Srouji SS. Robotic single-site myomectomy: a step-by-step tutorial. Fertil Steril. 2015; 104:e13.

15. Lewis EI, Srouji SS, Gargiulo AR. Robotic single-site myomectomy: initial report and technique. Fertil Steril. 2015; 103:1370–1377.e1.

16. Choi EJ, Rho AM, Lee SR, Jeong K, Moon HS. Robotic single-site myomectomy: clinical analysis of 61 consecutive cases. J Minim Invasive Gynecol. 2017; 24:632–639.

17. Advincula AP, Song A, Burke W, Reynolds RK. Preliminary experience with robot-assisted laparoscopic myomectomy. J Am Assoc Gynecol Laparosc. 2004; 11:511–518.

18. Pundir J, Pundir V, Walavalkar R, Omanwa K, Lancaster G, Kayani S. Robotic-assisted laparoscopic vs abdominal and laparoscopic myomectomy: systematic review and meta-analysis. J Minim Invasive Gynecol. 2013; 20:335–345.

19. Pitter MC, Srouji SS, Gargiulo AR, Kardos L, Seshadri-Kreaden U, Hubert HB, et al. Fertility and symptom relief following robot-assisted laparoscopic myomectomy. Obstet Gynecol Int. 2015; 2015:967568.

20. Eisenberg D, Vidovszky TJ, Lau J, Guiroy B, Rivas H. Comparison of robotic and laparoendoscopic single-site surgery systems in a suturing and knot tying task. Surg Endosc. 2013; 27:3182–3186.