ROBOTIC MYOMECTOMY

Dr Rooma Sinha, MD, DNBSenior Consultant Gynecologist & Laparoscopic Surgeon

Apollo Health City; HYDERABADwww.gynecologyhyderabad.com,

drroomasinha@hotmail.com 9550326662; 9849008180

WHAT ARE FIBROIDS?Fibroids are tumours of the uterine myometrium and are usually non cancerousMost often they are observed without any active treatmentFIBROIDS ARE ALSO CALLED MYOMAS

HOWEVER treatment is suggested if one of the following problems occur1.Heavy menstrual bleeding2.Pelvic discomfort3.Pelvic pain4.Infertility5.Rapid increase in size6.Bladder problems7.Rectal pressure8.Discomfort or pain with sexual intercourse

WHAT IS MYOMECTOMY?

Myomectomy is a surgical procedure that removes the fibroids but saves the uterus.

It is advised in younger patients who still want to preserve their reproductive capability.

WHAT ARE THE OPTIONS FOR MYOMECTOMY?1. ABDOMINAL MYOMECTOMY- This requires abdominal incision. In

this method the pain is more and recovery is slow. 2. VAGINAL MYOMECTOMY- When fibroid is in the lower part odf

the uterus it can be removed vaginally without requiring an abdominal incision. But very few fibroids can be operated vaginally.

ABDOMINAL MYOMECTOMY

VAGINAL MYOMECTOMY

Case of Large fibroid- successful myomectomy

MRI showing Large fibroid

Morcellated pieces of fibroid

WHAT ARE THE OPTIONS FOR MYOMECTOMY?3. LAPAROSCOPIC MYOMECTOMY- surgery is done by 1cm holes in the abdomen. Long instruments are introduced to complete the surgery4. HYSTEROSCOPIC MYOMECTOMY- submucous myoma is removed using a teleoscopic instrument through the vagina into the uterine cavity.5. ROBOTIC MYOMECTOMY- It is an advanced form of Laparoscopic surgery

WHY CHOOSE ROBOTIC MYOMECTOMY?

da Vinci ® Myomectomy A new category of minimally invasive myomectomy, combines the best of open and laparoscopic surgery.

With the assistance of Robotic Surgery-We can remove uterine fibroids through small incisions with unmatched precision and control

Robot-assisted surgery allows for superior visualization of the fibroids and the surrounding tissuesProvides Us with an improved ability to suture the uterus—resulting in less overall blood loss during the procedure compared to open or laparoscopic surgery.

Minimal scarring. Due to precise movement of robotic arms the tisue trauma is less leading to significantly less scarringLess blood loss. Better dissection in the right planes and the ability to suture more quickly, there is significantly less intra-operative blood lossLess post-operative pain. Less tissue trauma causes less tissue inflammation hence less pain.Faster recovery. Most patients are able to resume normal activities within 2 weeks, compared to 6 weeks for open surgery. Additionally, patients can go home the same day of the procedureExcellent suturing The excellent precision and visualization offered by the da Vinci Si enhances the surgeon's ability to suture the uterus appropriately.

Robotic Myomectomy-Advantages

Here are photos of ROBOTIC MYOMECTOMY done at Apollo Hospitals, Hyderabad

STEP 1. An incision is being made with the da Vinci robot over the fibroid on the uterine wall

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

STEP3. The dissection is complete and the The fibroid is almost free.

STEP 4. The fibroid is put in an Endobag for morcelation and removal

STEP 5. The uterine margins from the area where the myoma was removed is now being sutured in layers.

WHT ARE THE ALTERNATIVES TO MYOMECTOMY?

• Hysterectomy• Uterine artery emboization• MRgHIFU