Page 68 - World Journal of Laparoscopic Surgeons

Sugandha Agarwal
The aim of this review is to appraise the available RESULTS
literature on RA-LESS myomectomy and comment on the Lewis et al were the first to publish their experience
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feasibility, reproducibility, and learning curve as well as with robotic single-site myomectomy using the da Vinci
financial implication of this technique.
Si Surgical System in four patients. This was followed by
a step-by-step tutorial of their technique and results from
MATERIALS AND METHODS
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their first series of 10 women. Consecutively, in 2017, two
An electronic search was conducted using relevant key- studies were published; one was a retrospective analy-
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words and Mesh terms like single port, single incision, sis of 61 cases by Choi et al and another a prospective
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single site, laparoscopic myomectomy, robotic assisted. cohort of 21 patients by Gargiulo et al. Comparison of
PubMed, Google Scholar, and Cochrane central register for the outcomes is listed in Table 1.
controlled trials databases were searched to identify perti- Most of the patients in all the studies had a high
nent studies from 2010 to 2017. Studies where hybrid tech- body mass index (BMI). The mean size of the largest
niques, that is, robotic assistance combined with any other myoma that was enucleated was 6.73 ± 2.04 cm by Choi
17
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technique like conventional single site/multiport, mini et al and 5.7 ± 1.9 by Gargiulo et al and the largest
laparotomy were not included. As RA-LESS is a relatively myoma stood at 12.8 cm in diameter. Maximum number
newer technique, it was decided to include case studies, case of myomas removed from a single patient was 12. All
series, retrospective as well as prospective cohort studies for types including intramural, submucosal (International
analysis. Statistical Package for the Social Sciences software Federation of Gynecology and Obstetrics 2), subserosal,
was used for statistical analysis where required. broad ligament, and retroperitoneal as well as anterior,

Table 1: Comparison of included studies
Study Lewis et al 15 Gargiulo et al 16 Choi et al 17 Gargiulo et al 18
Type Case series Surgical video tutorial Retrospective analysis Prospective cohort
Technique used da Vinci RA-LESS with da Vinci RA-LESS with da Vinci single site da Vinci with standard
semirigid instruments semirigid instruments platform with specialized rigid instruments in
silicone port coaxial arrangement
Surgeon learning curve Surgeon with >8 years Not mentioned >200 cases of robotic Not mentioned
experience with da surgery and certification
Vinci, and >1 year with program in robotic
RA-LESS single-site surgery
Number of patients 4 10 61 21
2
BMI in kg/m (mean ± SD, 30.75 (25–35) Not mentioned 22.29 ± 4.05 (17.63–38) 29.4 ± 4.7
range)
Total operative time in min Median 210 (202–254) Median 202 (141–254) 135.98 ± 59.62 (60–295) 154.2 ± 55.2
(mean ± SD, range)
Blood loss in mL (mean ± Median 103 (75–300) Median 87.5 (10–300) 182.62 ± 153.02 57.9 ± 53.7
SD, range) (10–600)
Largest myoma size in cm Not mentioned Median 6 (4–8) 6.73 ± 2.04 (3.0–12.8) 5.7 ± 1.9
(mean ± SD, range)
Myoma weight in gm 106.4 (45.0–160.4) Median 70 (26–154) Not mentioned 81.6±51
(mean ± SD, range)
Maximum number (range) 7 (2–7) 8 (1–8) 12 (1–12) 8 (1–8)
Skin incision length in cm Not mentioned Not mentioned 2.70 ± 0.19 (2.4–3.10) Not mentioned
(mean ± SD, range)
Intraoperative complication None None None None
Intraoperative conversion None None None None
Duration of hospitalization <24 hour Not mentioned 4.21 ± 0.84 (3–6) 0.57 ± 0.87
in days
Early/late postoperative Temporary urinary None None Small bowel
complication retention—one obstruction—one
At 4 weeks—none Superficial cellulitis—one
Patient perception of Satisfied Not mentioned Not mentioned Not mentioned
cosmetic appearance
Financial implication Not mentioned Not mentioned Not mentioned Difference of $450
between RA-LESS and
its multiport counterpart
SD: Standard deviation
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