Our Summary

This research paper describes a new, less invasive way to remove fibroids (non-cancerous tumors in the uterus) while preserving fertility. This new technique is called robotic vaginal natural orifice transluminal endoscopic surgery (vNOTES). It’s done through the vagina, without needing to make an incision in the abdomen, which results in less blood loss.

The study showed that this method is a viable alternative to traditional methods and can be used for various gynecological procedures. It also suggested that surgeons can become proficient in this technique after performing it about 10 times.

The benefits of this vaginal approach include shorter hospital stays, less operative time, and quicker recovery compared to traditional methods. However, the limited space in the vagina can make it hard for surgeons to see and make precise movements. This is where the robotic technique comes in. It allows surgeons to make precise movements without needing a lot of space because the robot and camera are close to the tissue.

The paper presents a case study of a 28-year-old woman with a large fibroid who wanted to preserve her fertility. The operation was successful, with minimal blood loss, and she was discharged the same day.

The paper concludes that this robotic vNOTES technique combines the benefits of vaginal and robotic surgeries, maintains low blood loss, and allows patients to be discharged on the same day. However, the patient’s desire for future fertility, the size and location of the fibroid, and adequate space for vaginal port placement should be considered before choosing this procedure. The authors also recommend that women who have had this procedure should have a cesarean section before labor in all future pregnancies to reduce the risk of uterine rupture.

FAQs

  1. What is the new method for removing fibroids while preserving fertility?
  2. What are the benefits of the robotic vNOTES technique compared to traditional methods?
  3. What factors should be considered before choosing the robotic vNOTES technique for fibroid removal?

Doctor’s Tip

A helpful tip a doctor might tell a patient about myomectomy using the robotic vNOTES technique is to discuss with them the importance of considering their desire for future fertility, the size and location of the fibroid, and the placement of the vaginal port before choosing this procedure. It is also recommended for women who have had this procedure to have a cesarean section before labor in all future pregnancies to reduce the risk of uterine rupture.

Suitable For

Patients who are typically recommended myomectomy are those who have symptomatic fibroids that are causing pain, heavy menstrual bleeding, pressure on the bladder or rectum, or fertility issues. Patients who want to preserve their fertility or avoid a hysterectomy may also be recommended myomectomy. In the case of the robotic vNOTES technique, patients with large fibroids, a desire to preserve fertility, and a suitable size and location of the fibroid may be good candidates for this less invasive procedure. It is important for patients to discuss their individual circumstances with their healthcare provider to determine the best treatment option for their specific situation.

Timeline

Before myomectomy:

  • Patient may experience symptoms such as heavy menstrual bleeding, pelvic pain, and pressure
  • Patient undergoes diagnostic tests such as ultrasound or MRI to confirm the presence and location of fibroids
  • Patient discusses treatment options with their healthcare provider, including the possibility of myomectomy
  • Patient may undergo pre-operative testing and evaluations to ensure they are a suitable candidate for surgery

After myomectomy:

  • Patient undergoes robotic vaginal natural orifice transluminal endoscopic surgery (vNOTES) for fibroid removal
  • Surgery is successful with minimal blood loss
  • Patient is discharged the same day as surgery
  • Patient may experience some discomfort and require pain medication during the recovery period
  • Patient follows post-operative instructions provided by their healthcare provider, including restrictions on physical activity and follow-up appointments
  • Patient may experience improved symptoms such as decreased menstrual bleeding and relief from pelvic pain and pressure

Overall, the patient’s experience before and after myomectomy involves a process of evaluation, decision-making, surgery, and recovery aimed at addressing symptoms related to fibroids and preserving fertility.

What to Ask Your Doctor

Some questions a patient should ask their doctor about myomectomy using the robotic vNOTES technique include:

  1. What are the potential risks and complications associated with this procedure?
  2. How many times have you performed this specific type of surgery?
  3. Will this procedure affect my fertility or future pregnancies?
  4. What is the expected recovery time and post-operative care required?
  5. Are there any specific criteria or factors that make a patient a good candidate for this procedure?
  6. How does this technique compare to traditional methods in terms of effectiveness and outcomes?
  7. What are the chances of the fibroids returning after the surgery?
  8. Will I need any additional follow-up procedures or treatments after the surgery?
  9. How soon can I expect to return to my normal activities and routine?
  10. Are there any long-term effects or considerations I should be aware of after undergoing this procedure?

Reference

Authors: Sunkara S, Guan X. Journal: Fertil Steril. 2022 Aug;118(2):414-416. doi: 10.1016/j.fertnstert.2022.05.009. Epub 2022 Jun 9. PMID: 35691722