Robotic Single-Site Myomectomy: Clinical Analysis of 61 Consecutive Cases

Study Objectives To report 61 consecutive cases of successful robotic single-site myomectomy (RSSM), and to evaluate the feasibility and safety of RSSM. Design Retrospective analysis of 61 cases involving RSSM (Canadian Task Force classification III). Setting Department of Obstetrics and Gynecology, College of Medicine, Robot Surgery Center, Ewha Womans University, Seoul, Republic of Korea. Patients Sixty-one patients who underwent RSSM performed by 3 gynecologic surgeons at Ewha Womans University between December 2014 and May 2016. Interventions We analyzed the patients' baseline characteristics and surgical variables and the trends in operation-related variables according to surgeon's level of experience with RSSM. Measurements and Main Results There were no cases of conversion to laparotomy or robotic multisite myomectomy. RSSM was successful for multiple uterine myomas up to 12 in number and for large myomas up to 12.8 cm in longest diameter. In terms of myoma location, RSSM was successful for all types of myomas, including subserosal, intramural, and intraligamentary. The mean docking time was 5.45 ± 2.84 minutes (2.0∼12.0 minutes), mean total operation time was 135.98 ± 59.62 minutes (60∼295 minutes), mean estimated blood loss was 182.62 ± 153.02 mL (10∼600 mL), and mean skin incision length was 2.70 ± 0.19 cm (2.4∼3.10 cm). The mean time to postoperative gas passage was 28.71 ± 12.99 hours (3.33∼76.50 hours), and the mean duration of hospitalization was 4.21 ± 0.84 days (3∼6 days). No patient required additional analgesics other than applied intravenous patient-controlled analgesia. The mean change in hemoglobin level was 2.43 ± 0.87 g/dL, and the incidence of postoperative anemia requiring blood transfusion was only 3.3% (2 cases). No intraoperative or perioperative complications were noted. Conclusion RSSM is a feasible and safe procedure even in cases large, multiple, and intramural type myomas. Therefore, this option could be extended to appropriately selected patients.