FEATURES OF ROBOT-ASSISTED MYOMECTOMY
Main Article Content
Abstract
Objective – to study the results of surgical treatment of uterine fibroids using robot-assisted access with unidirectional suture materials, as well as with the use of temporary occlusion of the uterine arteries.
Materials and methods. An applied, single-center, comparative, non-randomized prospective study that included patients who underwent robot-assisted myomectomy between 2020 and 2025. Group I included 42 women who underwent myomectomy using monofilament material with separate interrupted sutures; Group II included 38 patients who underwent myomectomy using a unidirectional V-Loc thread; Group III included 34 patients who underwent myomectomy with temporary clipping of the uterine arteries.
Results. The duration of surgical intervention showed that the time of the myomectomy stage in group I was 113.5 ± 10.2 min, while in group II it was 96.8 ± 7.3 min. The volume of blood loss in group I was 226.5 ± 28.2 ml, in group II – 69.0 ± 14.7 mm. The duration of myorrhaphy was 15.8 ± 3.1 min in group I, while in group II it was 11.3 ± 1.2 min. The formation of hematomas in the suture area was 14.3% and 19%, the average volume of hematomas was 5.3 ± 1.8 ml and 23.5 ± 12.3 ml, respectively. Normal myometrial thickness in the scar area was 95.2% and 92.1%, absence of deformities and «niches» was 92.9% and 94.7%, and adequate myometrial blood flow in the scar projection was 85.7% and 86.8%, respectively. Clipping reduced blood loss by 191 ml.
Conclusions. The use of unidirectional sutures during robot-assisted myomectomy improves intraoperative outcomes without affecting the postoperative course or the quality of the resulting uterine scar. Temporary uterine artery occlusion is a safe method for reducing intraoperative blood loss.
Keywords
Article Details
Information about financing and conflict of interests
The authors declare that they have no apparent or potential conflicts of interest related to the publication of this article.
This work is licensed under a Creative Commons Attribution 4.0 License.
How to Cite
References
1. Wang L, Deng JY, Li KP, Zhu PY. A systematic review and meta-analysis comparing robotic single-site versus multi-port myomectomy. J Robot Surg. 2023; 17(4): 1319-1328. doi: 10.1007/s11701-023-01597-9
2. Arian SE, Munoz JL, Kim S, Falcone T. Robot-assisted laparoscopic myomectomy: current status. Robot Surg. 2017; 4: 7-18. doi: 10.2147/RSRR.S102743
3. Mourad A, Kamga-Ngande C, Albaini O, Antaki R. Enhancing surgical performance: the role of robotic surgery in myomectomies, a systematic review and metanalysis. J Robot Surg. 2024; 18(1): 184. doi: 10.1007/s11701-024-01953-3
4. Chen W, Ma J, Yang Z, Han X, Hu C, Wang H, et al. Robotic-assisted laparoscopic versus abdominal and laparoscopic myomectomy: A systematic review and meta-analysis. Int J Gynaecol Obstet. 2024; 166(3): 994-1005. doi: 10.1002/ijgo.15485
5. Hur C, Falcone T. Fertility and Pregnancy Outcomes after Robotic-assisted Laparoscopic Myomectomy in a Canadian Cohort. J Minim Invasive Gynecol. 2022; 29(1): 1-2. doi: 10.1016/j.jmig.2021.11.001
6. Popov AA, Fedorov AA, Glebov TA, Klyushnikov ID, Shmakov RG. Robot-assisted surgery in gynecology: experience of the Moscow Regional Research Institute of Obstetrics and Gynecology named after Academician V.I. Krasnopolsky. Bulletin of Roszdravnadzor. 2025; 1: 41-47. Russian (Попов А.А., Федоров А.А., Глебов Т.А., Клюшников И.Д., Шмаков Р.Г. Робот-ассистированная хирургия в гинекологии: опыт Московского областного научно-исследовательского института акушерства и гинекологии имени академика В.И. Краснопольского //Вестник Росздравнадзора. 2025. № 1. С. 41-47.)
7. Dou L, Zhang Y. Tips and Details for Successful Robotic Myomectomy: Single-Center Experience with the First 125 Cases. J Clin Med. 2022; 11(11): 3221. doi: 10.3390/jcm11113221
8. Lee CY, Chen IH, Torng PL. Robotic myomectomy for large uterine myomas. Taiwan J Obstet Gynecol. 2018; 57(6): 796-800. doi: 10.1016/j.tjog.2018.10.004
9. Shchukina NA, Buyanova SN, Babunashvili EL, Tikhomirova EV, Zemskova NYu, Glebov TA. Modern approaches to drug treatment of patients with combined proliferative diseases of the uterus. Russian Bulletin of Obstetrician-Gynecologist. 2022; 22(6): 102-108. Russian (Щукина Н.А., Буянова С.Н., Бабунашвили Е.Л., Тихомирова Е.В., Земскова Н.Ю., Глебов Т.А. Современные подходы к медикаментозному лечению пациенток с сочетанными пролиферативными заболеваниями матки //Российский вестник акушера-гинеколога. 2022. Т. 22, № 6. С. 102-108.) doi: 10.17116/rosakush202222061102
10. Babunashvili EL, Shchukina NA, Buyanova SN, Budykina TS, Tikhomirova EV, Glebov TA, et al. Possibilities of rehabilitation of patients of reproductive age after myomectomy. Russian Bulletin of Obstetrician-Gynecologist. 2022; 22(3): 93-99. Russian (Бабунашвили Е.Л., Щукина Н.А., Буянова С.Н., Будыкина Т.С., Тихомирова Е.В., Глебов Т.А., и др. Возможности реабилитации пациенток репродуктивного возраста после миомэктомии //Российский вестник акушера-гинеколога. 2022. Т. 22, № 3. С. 93-99.) doi: 10.17116/rosakush20222203193
11. Shchukina NA, Buyanova SN, Babunashvili EL, Zemskova NYu, Glebov TA, Son DYu, et al. Proliferative diseases of the uterus. What should be preferred in the postoperative rehabilitation program? Russian Bulletin of Obstetrician-Gynecologist. 2023; 23(5): 100-105. Russian (Щукина Н.А., Буянова С.Н., Бабунашвили Е.Л., Земскова Н.Ю., Глебов Т.А., Сон Д.Ю., и др. Пролиферативные заболевания матки. Что предпочесть в программе послеоперационной реабилитации? //Российский вестник акушера-гинеколога. 2023; 23(5): 100-105.) doi: 10.17116/rosakush202323051100
12 Shchukina NA, Kareva EN, Kochetkova AA, Babunashvili EL, Glebov TA, Kotsuba DR. Controversial issues of adjuvant therapy after myomectomy. Russian Bulletin of Obstetrician-Gynecologist. 2024; 24(5): 101-107. Russian (Щукина Н.А., Карева Е.Н., Кочеткова А.А., Бабунашвили Е.Л., Глебов Т.А., Коцуба Д.Р. Дискуссионные вопросы адъювантной терапии после миомэктомии //Российский вестник акушера-гинеколога. 2024. Т. 24, № 5. С. 101-107.) doi: 10.17116/rosakush202424051101
13 Sinha R, Rupa B. Robotic Myomectomy: Five Modifications in Our Practice. J Obstet Gynaecol India. 2022; 72(1): 89-92. doi: 10.1007/s13224-021-01553-3
14 Lonnerfors C. Robot-assisted myomectomy. Best Pract Res Clin Obstet Gynaecol. 2018; 46: 113-119. doi: 10.1016/j.bpobgyn.2017.09.005
15 Khan MTA, Patnaik R, Lee CS, Willson CM, Demario VK, Krell RW, Laverty RB. Systematic review of academic robotic surgery curricula. J Robot Surg. 2023; 17(3): 719-743. doi: 10.1007/s11701-022-01500-y
16 Jayakumaran J, Patel SD, Gangrade BK, Narasimhulu DM, Pandian SR, Silva C. Robotic-assisted laparoscopy in reproductive surgery: a contemporary review. J Robot Surg. 2017; 11(2): 97-109. doi: 10.1007/s11701-017-0682-4
17 Kim JJ, Choi C, Nam SH, Kim WY. Feasibility of Reduced-Port Robotic Surgery for Myomectomy with the da Vinci Surgical System. J Minim Invasive Gynecol. 2017; 24(6): 926-931. doi: 10.1016/j.jmig.2017.04.025
18. Gitas G, Hanker L, Rody A, Ackermann J, Alkatout I. Robotic surgery in gynecology: is the future already here? Minim Invasive Ther Allied Technol. 2022; 31(6): 815-824. doi: 10.1080/13645706.2021.2010763
19. Moon AS, Garofalo J, Koirala P, Vu MT, Chuang L. Robotic Surgery in Gynecology. Surg Clin North Am. 2020; 100(2): 445-460. doi: 10.1016/j.suc.2019.12.007
20. Won S, Choi SH, Kim SJ, Lee N, Shim SH, Kim M, et al. Comparison of cesarean delivery outcome after robotic and laparoscopic myomectomy. Taiwan J Obstet Gynecol. 2023; 62(1): 12-15. doi: 10.1016/j.tjog.2022.06.016