Our Summary

Robot-assisted laparoscopic surgery, a form of minimally invasive surgery, has seen global growth since it was approved by the FDA in 2005 for gynecologic surgeries. It has been used in a wide range of gynecologic procedures and conditions. This paper focuses specifically on how this technology has been applied to the treatment of uterine fibroids, a common condition where non-cancerous growths develop in the uterus. The surgery, known as robot-assisted laparoscopic myomectomy (RALM), uses the daVinci Surgical System, a high-tech robot designed by Intuitive Surgical. This paper reviews the surgical technique used in RALM and provides an evidence-based analysis of the current scientific literature on the subject.

FAQs

  1. What is the role of robot-assisted laparoscopic myomectomy in the surgical management of uterine fibroids?
  2. When was robot-assisted laparoscopic surgery approved for use in gynecologic procedures?
  3. What is the daVinci Surgical System mentioned in the context of robot-assisted laparoscopic myomectomy?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about myomectomy is to discuss with them the potential benefits and risks of robot-assisted laparoscopic myomectomy. This minimally invasive approach can lead to shorter hospital stays, faster recovery times, and less scarring compared to traditional open surgery. It is important for the patient to follow pre-operative instructions, such as fasting before the surgery, and post-operative care guidelines to ensure a successful outcome. Additionally, the doctor may recommend regular follow-up appointments to monitor the patient’s recovery and address any concerns.

Suitable For

Patients who are typically recommended myomectomy include those with symptomatic uterine fibroids who desire to preserve their fertility or avoid a hysterectomy. Additionally, patients with large or multiple fibroids, those with rapid growth of fibroids, and those with symptoms such as heavy menstrual bleeding, pelvic pain, or pressure symptoms may also benefit from myomectomy. Robot-assisted laparoscopic myomectomy (RALM) with the daVinci Surgical System is a minimally invasive option that may be particularly suitable for patients with these characteristics.

Timeline

Before myomectomy:

  • Patient experiences symptoms of uterine fibroids such as heavy menstrual bleeding, pelvic pain, and pressure on the bladder or rectum.
  • Patient undergoes diagnostic tests such as ultrasound or MRI to confirm the presence of fibroids.
  • Patient consults with a gynecologist to discuss treatment options, including the possibility of myomectomy.
  • Patient undergoes pre-operative evaluations and preparations, such as blood tests and physical examinations.

After myomectomy:

  • Patient undergoes robot-assisted laparoscopic myomectomy (RALM) using the daVinci Surgical System.
  • Surgery is performed through small incisions in the abdomen, with the robotic arms controlled by the surgeon from a console.
  • Fibroids are removed from the uterus, preserving the uterus and fertility.
  • Patient stays in the hospital for a few days for monitoring and recovery.
  • Patient is discharged home with instructions for post-operative care and follow-up appointments.
  • Patient experiences a recovery period, with gradual improvement in symptoms and return to normal activities.
  • Patient may experience improvements in menstrual bleeding, pain, and other symptoms related to fibroids.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a myomectomy procedure?
  2. How long is the recovery process expected to be after a myomectomy?
  3. Will a myomectomy affect my fertility or future pregnancies?
  4. What are the chances of the fibroids recurring after a myomectomy?
  5. Are there alternative treatment options for my fibroids besides a myomectomy?
  6. What is the success rate of robot-assisted laparoscopic myomectomy compared to traditional surgical methods?
  7. How experienced are you in performing robot-assisted laparoscopic myomectomy procedures?
  8. What can I expect during the procedure and how long will it take?
  9. Will I need to stay in the hospital after the myomectomy, and if so, for how long?
  10. How soon after the myomectomy can I resume normal activities and exercise?

Reference

Authors: Advincula AP. Journal: Best Pract Res Clin Obstet Gynaecol. 2024 Mar;93:102452. doi: 10.1016/j.bpobgyn.2023.102452. Epub 2023 Dec 24. PMID: 38359581