Page 75 - World Journal of Laparoscopic Surgeons

Sugandha Agarwal
diameter (< 6, 6–10, and >10 cm). The mean myoma diam- 3. Palomba S, Zupi E, Falbo A, Russo T, Marconi D, Tolino A,
eter was 4.99 ± 0.79 cm in the < 6 cm group, 7.33 ± 0.90 cm Manguso F, Mattei A, Zullo F. A multicenter randomized,
in the 6 to 10 cm group, and 11.66 ± 0.99 cm in the >10 cm controlled study comparing laparoscopic versus minilapa-
group. There were no statistically significant differences rotomic myomectomy: reproductive outcomes. Fertil Steril
2007 Oct;88(4):933-941.
across the three groups in total operation time. However, 4. Bush AJ, Morris SN, Millham FH, Isaacson KB. Women’s pref-
the expected blood loss was lowest in the <6 cm group erences for minimally invasive incisions. J Minim Invasive
(132.80 ± 122.32 mL) compared with the other two groups Gynecol 2011 Sep-Oct;18(5):640-643.
(210.97 ± 157.72 mL in the 6 to 10 cm group and 256.00 ± 5. Goebel K, Goldberg JM. Women’s preference of cosmetic
215.48 mL in the >10 cm group), representing a statisti- results after gynecologic surgery. J Minim Invasive Gynecol
2014 Jan-Feb;21(1):64-67.
cally significant trend (p = 0.078). 6. FDA Safety Communication. Updated laparoscopic uterine
It is important to note that robotic myomectomy is power morcellation in hysterectomy and myomectomy.
a significantly lengthier procedure compared with con- 2014. Available from: http://www.fda.gov/MedicalDevices/
13
ventional laparoscopic myomectomy, but the robotic Safety/AlertsandNotices/ucm424443.htm.
platform allows for a broader range of applications com- 7. Han CM, Lee CL, Su H, Wu PJ, Wang CJ, Yen CF. Single-
pared with conventional laparoscopy for this indication. port laparoscopic myomectomy: initial operative experi-
ence and comparative outcome. Arch Gynecol Obstet 2013
Also, the obese can realize the same clinical and quality Feb;287(2):295-300.
benefits of minimally invasive surgery as the nonobese 8. Choi CH, Kim TH, Kim SH, Choi JK, Park JY, Yoon A, Lee YY,
at the cost of additional operative time. Kim TJ, Lee JW, Kim BG, et al. Surgical outcomes of a new
One of the aims of this study was to analyze the approach to laparoscopic myomectomy: single-port and
comprehensive cost of this procedure. However, none of modified suture technique. J Minim Invasive Gynecol 2014
Jul-Aug;21(4):580-585.
the studies reported on the cost analysis. Only one study 9. Yoshiki N, Okawa T, Kubota T. Single-incision laparoscopic
compared the robotic modality with its laparoscopic myomectomy with intracorporeal suturing. Fertil Steril 2011
counterpart and found an associated higher cost with the Jun;95(7):2426-2428.
18
robotic technique. This is an important area that needs 10. Bendient CE, Magrina JF, Noble BN, Kho RM. Comparison of
to be further studied, especially, to understand if a wider robotic and laparoscopic myomectomy. Am J Obstet Gynecol
application of this technique is economically feasible. 2009 Dec;201(6):566.e1-566.e5.
Another limitation is that in all the studies, the surgeries 11. Nezhat C, Lavie O, Hsu S, Watson J, Barnett O, Lemyre M.
Robotic-assisted laparoscopic myomectomy compared
were performed by highly experienced surgeons in the with standard laparoscopic myomectomy—a retrospec-
field of minimally invasive and robot-assisted surgery, tive matched control study. Fertil Steril 2009 Feb;91(2):
and it is, therefore, unclear whether these techniques 556-559.
would translate to successful adoption by the larger 12. Advincula AP, Xu X, Goudeau S 4th, Ransom SB. Robot-
surgical community. assisted laparoscopic myomectomy versus abdominal
myomectomy: a comparison of short-term surgical outcomes
and immediate costs. J Minim Invasive Gynecol 2007 Nov-
CONCLUSION Dec;14(6):698-705.
13. Gargiulo AR, Srouji SS, Missmer SA, Correia KF, Vellinga TT,
Current initial data indicate that RA-LESS is a promis- Einarsson JI. Robot-assisted laparoscopic myomectomy
ing technique. It is a safe, feasible, and reproducible compared with standard laparoscopic myomectomy. Obstet
procedure for performing myomectomy. However, more Gynecol 2012 Aug;120(2 Pt 1):284-291.
studies with larger cohorts and long-term follow-ups are 14. Eisenberg D, Vidovszky TJ, Lau J, Guiroy B, Rivas H. Com-
needed to conclusively recommend this technique for a parison of robotic and laparoendoscopic single-site surgery
wider application. Also, the exact indications for its use systems in a suturing and knot tying task. Surg Endosc 2013
Sep;27(9):3182-3186.
and patient selection criteria for optimum outcome still 15. Lewis EI, Srouji SS, Gargiulo AR. Robotic single site myo-
need to be determined. mectomy: initial report and technique. Fertil Steril 2015
May;103(5):1370-1377.
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