Robotic single site myomectomy Initial report and technique

Capsule:
Robotic single-site myomectomy is a safe and reproducible reproductive surgery technique. We report our initial experience with an original step-by-step protocol using novel wristed instrumentation.

Authors:
Erin I. Lewis, M.D., Serene S. Srouji, M.D., Antonio R. Gargiulo, M.D.

Volume 103, Issue 5, Pages 1370-1377

Abstract:

Objective:
To report the first cases of robotic single-site (RSS) myomectomy with the use of the Da Vinci Si Surgical System with wristed semirigid instrumentation.

Design:
Case series.

Setting:
University hospital.

Patient(s):
Four patients with symptomatic uterine fibroids desiring conservative minimally invasive surgical treatment.

Intervention(s):
Four RSS myomectomies were performed with the Da Vinci Single-Site platform. Data regarding patient characteristics, indication of surgery, and perioperative outcomes were collected.

Main Outcome Measure(s):
Safety and reproducibility of RSS myomectomy.

Result(s):
All RSS procedures were completed successfully. Median operative time was 210 minutes (range 202–254 min). Median blood loss was 103 mL (range 75–200 mL). No instrument failures were noted during the procedures. No operative or major postoperative complications occurred. Two patients were discharged on the day of surgery, and two were discharged after overnight observation.

Conclusion(s):
RSS myomectomy with the use of wristed semi-rigid instrumentation is a feasible procedure. Indications, safety, and use of the technique will be confirmed by growing experience.

  • Jason M. Franasiak

    Congratulations on this very nice manuscript. Although not the focus of your study, cost associated with surgical procedures, particularly robotic vs. straight stick laparoscopic procedures, continues to be an area of focus. How does the cost of a robotic single-site procedure compare with standard robotic procedures?

    • Dear Jason:
      I appreciate your comment (and your own important scientific contribution to this field). AT this point (9 months into the first developmemt of the technique) our average time for single site myomectomy is just under three hours. We only use two robotic instruments per case (two wristed needle drivers). We do use an OmniGuide fiber: one could argue that a simple non-wristed monopolar hook could be used with similar results (but I do not think that the two come even close to each other conceptually). Morcellation is not an potion at BWH, so we have to use a retrieval system in both multi-port and single-site. All in all I would say that we save a few OR minutes on the single-site cases, as well as saving one instrument “life”. Not much of a difference though. Not more expensive that multi-port for sure though.

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