Abstract
We report our experience with coaxial robot-assisted laparoendoscopic single-site (RA-LESS) myomectomy, including a detailed description of the technique and outcomes from our first 21 cases. This was a retrospective cohort study carried out at the reproductive endocrinology and gynecologic oncology divisions at two academic medical centers. RA-LESS myomectomy was performed with the da Vinci Si Surgical System (Intuitive Surgical, Inc, Sunnyvale, CA, USA) employing standard rigid 8 or 5 mm instrumentation in a coaxial arrangement through a standard laparoendoscopic single-site (LESS) port (GelPOINT Advanced Access Platform, Applied Medical, Rancho Santa Margarita, CA, USA). Cases were completed between October 2011 and November 2013. Twenty-one patients underwent surgery. Mean age (±SD) was 38.1 ± 5.8 years, and mean BMI was 29.4 ± 4.7 kg/m2. Menorrhagia, pelvic pressure, and urinary frequency were the main presenting symptoms. Mean diameter of the largest tumor was 5.7 ± 1.9 cm (median 5.9 cm, range 2.1–9.5 cm), while mean number of tumors removed was 2.2 ± 1.8, ranging from 1 to 8 per surgery. Mean operative time was 154.2 ± 55.2 min (median 152 min, range 85–290 min). Mean blood loss was 57.9 ± 53.7 cc (median 50 cc, range 5–200 cc) and length of hospital stay ranged between 0 and 3 days (median 0). All procedures were successfully performed without conversion to conventional LESS surgery, multi-port laparoscopy or laparotomy. RA-LESS myomectomy with coaxial use of standard rigid instrumentation is a safe and reproducible addition to the minimally invasive surgeons’ armamentarium, with excellent cosmetic and postoperative outcomes in selected patients. Further investigation is needed to define the patient groups that will most benefit from it.
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References
Sizzi O, Rossetti A, Malzoni M et al (2007) Italian multicenter study on complications of laparoscopic myomectomy. J Minim Invasive Gynecol. 14:453–462
Mais V, Ajossa S, Guerriero S et al (1996) Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol 174:654–658
Seracchioli R, Rossi S, Govoni F et al (2000) Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod 15:2663–2668
Palomba S, Zupi E, Falbo A et al (2007) A multicenter randomized, controlled study comparing laparoscopic versus minilaparotomic myomectomy: reproductive outcomes. Fertil Steril 88:933–941
Liu G, Zolis L, Kung R et al (2010) The laparoscopic myomectomy: a survey of Canadian gynaecologists. J Obstet Gynaecol Can 32:139–148
Barakat EE, Bedaiwy MA, Zimberg S et al (2011) Robotic-assisted, laparoscopic, and abdominal myomectomy: a comparison of surgical outcomes. Obstet Gynecol 117:256–265
Kosumi T, Kubota A, Usui N et al (2001) Laparoscopic ovarian cystectomy using a single umbilical puncture method. Surg Laparosc Endosc Percutan Tech 11:63–65
Bush AJ, Morris SN, Millham FH et al (2011) Women’s preferences for minimally invasive incisions. J Minim Invasive Gynecol 18:640–643
Goebel K, Goldberg JM (2014) Women’s preference of cosmetic results after gynecologic surgery. J Minim Invasive Gynecol 21:64–67
Yeung PP Jr, Bolden CR, Westreich D et al (2013) Patient preferences of cosmesis for abdominal incisions in gynecologic surgery. J Minim Invasive Gynecol 20:79–84
FDA Safety Communication. Updated laparoscopic uterine power morcellation in hysterectomy and myomectomy: 11.24.2014. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm424443.htm
Ghezzi F, Cromi A, Fasola M et al (2005) One-trocar salpingectomy for the treatment of tubal pregnancy: a ‘marionette-like’ technique. BJOG 112:1417–1419
Lee YY, Kim TJ, Kim CJ et al (2009) Single-port access laparoscopic-assisted vaginal hysterectomy: a novel method with a wound retractor and a glove. J Minim Invasive Gynecol 16:450–453
Han CM, Lee CL, Su H et al (2013) Single-port laparoscopic myomectomy: initial operative experience and comparative outcome. Arch Gynecol Obstet 287:295–300
Choi CH, Kim TH, Kim SH et al (2014) Surgical outcomes of a new approach to laparoscopic myomectomy: single-port and modified suture technique. J Minim Invasive Gynecol 21:580–585
Yoshiki N, Okawa T, Kubota T (2011) Single-incision laparoscopic myomectomy with intracorporeal suturing. Fertil Steril 95:2426–2428
Gill IS, Advincula AP, Aron M et al (2010) Consensus statement of the consortium for laparoendoscopic single-site surgery. Surg Endosc 24:762–768
Eisenberg D, Vidovszky TJ, Lau J et al (2013) Comparison of robotic and laparoendoscopic single-site surgery systems in a suturing and knot tying task. Surg Endosc 27:3182–3186
Sendag F, Akdemir A, Oztekin MK (2014) Robotic single-incision transumbilical total hysterectomy using a single-site robotic platform: initial report and technique. J Minim Invasive Gynecol. 21:147–151
Pluchino N, Buchs NC, Drakopoulos P et al (2014) Robotic single-site combined cholecystectomy and hysterectomy: advantages and limits. Int J Surg Case Rep. 5:1025–1027
Scheib SA, Fader AN (2015) Gynecologic robotic laparoendoscopic single-site surgery: prospective analysis of feasibility, safety, and technique. Am J Obstet Gynecol 212(179):e171–e178
Nam EJ, Kim SW, Lee M et al (2011) Robotic single-port transumbilical total hysterectomy: a pilot study. J Gynecol Oncol 22:120–126
Lewis EI, Srouji SS, Gargiulo AR (2015) Robotic single-site myomectomy: initial report and technique. Fertil Steril 103(1370–1377):e1371
Gargiulo AR, Bailey AP, Srouji SS (2013) Robot-assisted single-incision laparoscopic myomectomy: initial report and technique. J Robot Surg. 7:137–142
Escobar PF, Fader AN, Paraiso MF et al (2009) Robotic-assisted laparoendoscopic single-site surgery in gynecology: initial report and technique. J Minim Invasive Gynecol. 16:589–591
Tinelli A, Malvasi A, Guido M et al (2011) Adhesion formation after intracapsular myomectomy with or without adhesion barrier. Fertil Steril 95:1780–1785
Rosenbaum L (2016) N-of-1 policymaking-tragedy, trade-offs, and the demise of morcellation. N Engl J Med 374:986–990
Srouji SS, Kaser DJ, Gargiulo AR (2015) Techniques for contained morcellation in gynecologic surgery. Fertil Steril 103:e34
Kim TJ, Lee YY, An JJ et al (2012) Does single-port access (SPA) laparoscopy mean reduced pain? A retrospective cohort analysis between SPA and conventional laparoscopy. Eur J Obstet Gynecol Reprod Biol 162:71–74
Kim TJ, Lee YY, Cha HH et al (2010) Single-port-access laparoscopic-assisted vaginal hysterectomy versus conventional laparoscopic-assisted vaginal hysterectomy: a comparison of perioperative outcomes. Surg Endosc 24:2248–2252
Yim GW, Jung YW, Paek J et al (2010) Transumbilical single-port access versus conventional total laparoscopic hysterectomy: surgical outcomes. Am J Obstet Gynecol 203(26):e21–e26
Caillet M, Vandromme J, Rozenberg S et al (2010) Robotically assisted laparoscopic microsurgical tubal reanastomosis: a retrospective study. Fertil Steril 94:1844–1847
Gargiulo AR, Srouji SS, Missmer SA et al (2012) Robot-assisted laparoscopic myomectomy compared with standard laparoscopic myomectomy. Obstet Gynecol 120:284–291
Kim YW, Park BJ, Ro DY et al (2010) Single-port laparoscopic myomectomy using a new single-port transumbilical morcellation system: initial clinical study. J Minim Invasive Gynecol. 17:587–592
Einarsson JI (2010) Single-incision laparoscopic myomectomy. J Minim Invasive Gynecol 17:371–373
Sesti F, Boccia C, Sorrenti G et al (2013) Single-incision laparoscopic adnexectomy in an obese patient with previous laparotomies. JSLS. 17:164–166
Escobar PF, Bedaiwy MA, Fader AN et al (2010) Laparoendoscopic single-site (LESS) surgery in patients with benign adnexal disease. Fertil Steril 93:2074 e2077–2010
Murji A, Patel VI, Leyland N et al (2013) Single-incision laparoscopy in gynecologic surgery: a systematic review and meta-analysis. Obstet Gynecol 121:819–828
Choussein S, Srouji SS, Farland LV et al (2015) Flexible carbon dioxide laser fiber versus ultrasonic scalpel in robot-assisted laparoscopic myomectomy. J Minim Invasive Gynecol. 22:1183–1190
Keller DS, Ibarra S, Flores-Gonzalez JR et al (2016) Outcomes for single-incision laparoscopic colectomy surgery in obese patients: a case-matched study. Surg Endosc 30:739–744
Beninato T, Kleiman DA, Soni A et al (2015) Expanding the indications for single-incision laparoscopic cholecystectomy to all patients with biliary disease: is it safe? Surg Laparosc Endosc Percutan Tech. 25:10–14
Wright JD, Tergas AI, Cui R, Burke WM, Hou JY, Ananth CV, Chen L, Richards C, Neugut AI, Hershman DL (1010) Use of electric power morcellation and prevalence of underlying cancer in women who undergo myomectomy. JAMA Oncol. doi:10.1001/jamaoncol.2014.206
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Dr. Gargiulo reports personal fees from OmniGuide Inc., and Kawasaki Robotics (USA), Inc. outside the submitted work. Dr. Choussein declares that she has no conflict of interest. Dr. Srouji declares that she has no conflict of interest. Dr. Cedo declares that she has no conflict of interest. Dr. Escobar declares that he has no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
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Informed consent was obtained from all individual participants included in the study.
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Gargiulo, A.R., Choussein, S., Srouji, S.S. et al. Coaxial robot-assisted laparoendoscopic single-site myomectomy. J Robotic Surg 11, 27–35 (2017). https://doi.org/10.1007/s11701-016-0603-y
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DOI: https://doi.org/10.1007/s11701-016-0603-y