Page 67 - World Journal of Laparoscopic Surgeons

WJOLS
WJOL S

10.5005/jp-journals-10007-1330
Robot-assisted Laparoendoscopic Single-site Myomectomy
RevieW aRticLe

Robot-assisted Laparoendoscopic Single-site

Myomectomy: Current Status

Sugandha Agarwal

ABSTRACT is forever optimistically moving forward in hope of
Introduction: The commercial availability of robotic da Vinci performing safe surgical procedures with cosmeti-
surgical system (Intuitive Surgical inc., Sunnyvale, California, cally smaller and fewer scars to the patient, as well as
USA) has attracted the gynecologic surgeon’s interest due improving peri/postoperative surgical outcomes. With
to proposed favorable surgical ergonomics, greater preci-
sion in dissection, and easier suturing as well as knot tying. the progression in the learning curve, surgeons are now
Robot-assisted laparoendoscopic single-site surgery appears inclined to perform more challenging procedures, such
to be encouraging for more suture-intensive surgeries like as myomectomy via the minimally invasive route.
myomectomy as it offers potential in resolving the ergonomic
challenges imposed by the restrictive range of motion and vision Clinical advantages of conventional multiport lapa-
of conventional LESS. roscopic myomectomy over abdominal myomectomy in
Aim: The aim of this review is to appraise the available literature young women seeking fertility preservation are now well
1-3
on robot-assisted laparoendoscopic single-site (RA-LESS) proven. Furthering the minimally invasive approach,
myomectomy and comment on the feasibility, reproducibility, laparoendoscopic single-site surgery (LESS) has been
learning curve as well as financial implications of this technique.
adopted by the surgeons due to better cosmetic accep-
Results: The studied outcome measures of mean operative tance by the patients. Additionally, the wider umbilical
4,5
time, estimated blood loss, and number and type of myomas
removed suggest that this is a feasible technique. It was found access associated with LESS provides for an alternative to
to be a safe procedure with no reported intraoperative compli- electromechanical morcellator for contained mechanical
cations or conversions and negligible postoperative complica- tissue extraction. This feature becomes more relevant to
tions. The data on financial implication are, however, limited.
gynecologic surgeons owing to the recently imposed ban
Conclusion: Current initial data indicate that RA-LESS is a
promising technique. It is a safe and reproducible procedure by US Food and Drug Administration (FDA) on the use
6
for performing myomectomy. However, more studies with larger of electromechanical morcellators. However, the use of
cohorts and long-term follow-ups are needed to conclusively LESS for myomectomy has not gained wide popularity
recommend this technique for a wider application. due to intensive reconstruction and suturing required
Clinical significance: With increasing experience in minimal as well as lack of proven robust surgical benefits when
invasive techniques and availability of single-port da Vinci surgi- 7-9
cal system, more challenging surgeries like myomectomy can compared with conventional multiport myomectomy.
be safely performed to optimize clinical benefits to the patients. Other challenges posed by LESS like manipulation of
Keywords: Myomectomy, Robotic, Single site. three articulating instruments through one access port,
How to cite this article: Agarwal S. Robot-assisted Laparo- lack of triangulation, instrument crowding or clashing,
endoscopic Single-site Myomectomy: Current Status. World J poor ergonomics, and a long learning curve make it a
Lap Surg 2018;11(1):33-37. less favored choice for a demanding surgery, such as
Source of support: Nil myomectomy.
Conflict of interest: None The commercial availability of robotic da Vinci surgi-
cal system (Intuitive Surgical inc., Sunnyvale, California,
INTRODUCTION USA) has attracted the gynecologic surgeon’s interest
due to proposed favorable surgical ergonomics, greater
Minimally invasive surgery for gynecological proce- precision in dissection, and easier suturing as well as
dures has gained worldwide acceptance. This specialty knot tying. Robot-assisted laparoscopic myomectomy

has shown similar surgical outcomes as conventional
Research Officer laparoscopy and has gained acceptance as a safe and
reproducible operation. 10-13 Robot-assisted laparoendo-
Department of Obstetrics and Gynecology, Vardhman Mahavir
Medical College & Safdarjung Hospital, New Delhi, India scopic single-site surgery appears to be encouraging for
Corresponding Author: Sugandha Agarwal, Research Officer more suture intensive surgeries like myomectomy as it
Department of Obstetrics and Gynecology, Vardhman Mahavir offers potential in resolving the ergonomic challenges
Medical College & Safdarjung Hospital, New Delhi, India, Phone: imposed by the restrictive range of motion and vision
+911244275822, e-mail: agarwalsugandha29@gmail.com
of conventional LESS. 14
World Journal of Laparoscopic Surgery, January-April 2018;11(1):33-37 33