Our Summary

Uterine fibroids are the most common tumors found in the uterus and can cause significant health problems for many women. When medication isn’t effective, a surgery known as a myomectomy is often necessary, especially for women who want to maintain their ability to have children. While less invasive surgeries are usually better, most of these surgeries are still performed using a more invasive method called laparotomy.

Robotic surgery was developed to address some of the challenges of less invasive laparoscopic surgery. A myomectomy is a complex surgery that requires a lot of suturing, or stitching, and the precision of a robot can be very useful in this context. Robotic myomectomies are possible and safe, with similar results to traditional laparoscopic surgery. However, they are more expensive.

The development of robotic surgery has made less invasive myomectomy surgeries possible for more complicated cases that would have previously required a laparotomy. We still need more research, including randomized trials comparing different methods of myomectomy, to figure out when a robotic approach is most beneficial for patients and whether the higher cost is justified by the outcomes.

FAQs

  1. What is a myomectomy and why is it the preferred surgical procedure for women wishing to preserve fertility?
  2. How does robotic myomectomy compare to laparoscopic surgery in terms of safety, outcomes, and cost?
  3. Are there any published trials comparing different approaches to myomectomy and what further research is needed in this field?

Doctor’s Tip

A helpful tip a doctor might tell a patient about myomectomy is to discuss the possibility of robotic surgery as an option for the procedure. Robotic myomectomy is feasible and safe, with similar outcomes to laparoscopic surgery, but may have a higher cost. It is important to weigh the potential benefits of a robotic approach, such as shorter recovery time and less scarring, against the cost and make an informed decision based on individual circumstances.

Suitable For

Patients who are typically recommended for myomectomy are women with symptomatic uterine fibroids who wish to preserve their fertility. Myomectomy is the surgical procedure of choice for these patients when medical therapy is inadequate. Additionally, patients with large or multiple fibroids, those with severe symptoms such as heavy menstrual bleeding or pelvic pain, and those with fibroids causing infertility or pregnancy complications may also be recommended for myomectomy.

Robotic surgery has been introduced as an alternative to traditional laparoscopic myomectomy, offering potential benefits such as improved visualization and precision. Robotic myomectomy is feasible and safe, with similar outcomes to laparoscopic surgery, although it is associated with a higher cost. The use of robotic surgery has expanded the indications for minimally invasive myomectomy to more complex cases previously performed by laparotomy.

Further research is needed to determine which patients would benefit most from a robotic approach in terms of patient outcomes and cost efficiency. Randomized trials comparing different approaches to myomectomy are still needed to provide more definitive evidence on the optimal treatment for patients with uterine fibroids.

Timeline

Before myomectomy:

  1. Patient experiences symptoms such as heavy menstrual bleeding, pelvic pain, and frequent urination due to uterine fibroids.
  2. Patient undergoes imaging tests such as ultrasound or MRI to diagnose and assess the size and location of the fibroids.
  3. Patient may have tried medical therapy such as hormone therapy or pain medication to manage symptoms without success.
  4. Patient consults with a gynecologist or a gynecologic surgeon to discuss treatment options, including myomectomy.

After myomectomy:

  1. Patient undergoes pre-operative assessment and preparation for surgery, which may include blood tests, imaging studies, and discussions about anesthesia.
  2. Myomectomy is performed, either through traditional open surgery, laparoscopic surgery, or robotic surgery.
  3. Patient stays in the hospital for a few days for recovery and monitoring.
  4. Patient may experience post-operative pain, fatigue, and temporary limitations on physical activities.
  5. Patient follows up with the surgeon for monitoring of recovery and any potential complications.
  6. Over time, patient experiences relief from symptoms such as improved menstrual bleeding, decreased pelvic pain, and improved quality of life.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a myomectomy procedure?
  2. How long is the recovery period after a myomectomy surgery?
  3. Will my fertility be affected by this procedure?
  4. Are there any alternative treatment options for my fibroids?
  5. How many myomectomies have you performed, and what is your success rate?
  6. Will I need to undergo any additional tests or imaging before the surgery?
  7. What type of anesthesia will be used during the procedure?
  8. Will the fibroids likely return after the surgery?
  9. How long will the surgery take, and how long will I need to stay in the hospital?
  10. What is the expected outcome of the surgery in terms of symptom relief and future fertility?

Reference

Authors: Lonnerfors C. Journal: Best Pract Res Clin Obstet Gynaecol. 2018 Jan;46:113-119. doi: 10.1016/j.bpobgyn.2017.09.005. Epub 2017 Sep 29. PMID: 29103894