Robotic Myomectomy with da Vinci Surgical Robot

June 22, 2011

It is advantageous to perform surgery in the least invasive way possible while still getting optimal results. Although I usually prefer to do surgery through a laparoscope rather than through a larger incision, I have felt limited by the lack of wrist-like movements of the instruments. I felt that deeper myomas (that couldn’t be removed by a hysteroscope) were better removed through a regular incision.

It is advantageous to perform surgery in the least invasive way possible while still getting optimal results. Although I usually prefer to do surgery through a laparoscope rather than through a larger incision, I have felt limited by the lack of wrist-like movements of the instruments. I felt that deeper myomas (that couldn’t be removed by a hysteroscope) were better removed through a regular incision.

The da Vinci surgical robot is a major advance in the ability to precisely operate through small incisions. As shown below, the surgeon sits at a console (see photo) and looks through a 3-dimensional videocamera

The hand movements in the surgeon are duplicated in the patient by the robot. Most importantly, the instruments duplicate the wrist movements of the surgeon, allowing the instruments to change angles to allow precise suturing. (Photo below shows robot being used in delicate heart surgery.)

Here are photos of an actual robotic myomectomy in which I removed 5 fibroids:

1. An incision is being made with the da Vinci robot through the myometrium (muscle of the uterus) down to the fibroid.

2. The fibroid is grasped and dissected away from the surrounding myometrium.

3. The fibroid is almost free. Another small fibroid, which will also be removed, is seen at the bottom right.

4. The area where the myoma was is being sutured in layers.

The da Vinci does not always eliminate the need for abdominal myomectomy. When there are very large myomas and/or many myomas an abdominal myomectomy may be preferable.

I frequently get email asking how big is big and how many are too many. All of this is relative. The size of the uterus, the size of the woman, and the desire to retain fertility are only a few of the factors that enter into the decision making process. I can not make meaningful recommendations without actually seeing you! I frequently find that the records are quite different than what I find on my own evaluation, and that my recommendations after seeing someone are totally different than I would have made from reviewing records alone.

Visit Dr. Indman's web sites: All About Myomectomy and Alternatives in Gynecology
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The medical information presented in this website represents the opinion of Dr. Indman, and is based on his knowledge and experience. It is not applicable to all patients or physicians. Anyone visiting this or other related medical sites should discuss symptoms, findings, and alternatives with their personal gynecologist.