ROBOTIC MYOMECTOMY

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ROBOTIC MYOMECTOMY

• Dr Rooma Sinha, MD, DNB
• Senior Consultant Gynecologist Laparoscopic
  Surgeon
• Apollo Health City HYDERABAD
• www.gynecologyhyderabad.com, drroomasinha_at_hotmail.
  com
• 9550326662 9849008180

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WHAT ARE FIBROIDS?

• Fibroids are tumours of the uterine myometrium
  and are usually non cancerous
• Most often they are observed without any active
  treatment
• FIBROIDS ARE ALSO CALLED MYOMAS
• HOWEVER treatment is suggested if one of the
  following problems occur
• Heavy menstrual bleeding
• Pelvic discomfort
• Pelvic pain
• Infertility
• Rapid increase in size
• Bladder problems
• Rectal pressure
• Discomfort or pain with sexual intercourse

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WHAT IS MYOMECTOMY?
Myomectomy is a surgical procedure that removes
the fibroids but saves the uterus. It is
advised in younger patients who still want to
preserve their reproductive capability.
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WHAT ARE THE OPTIONS FOR MYOMECTOMY?

• ABDOMINAL MYOMECTOMY- This requires abdominal
  incision. In this method the pain is more and
  recovery is slow.
• VAGINAL MYOMECTOMY- When fibroid is in the lower
  part odf the uterus it can be removed vaginally
  without requiring an abdominal incision. But very
  few fibroids can be operated vaginally.

VAGINAL MYOMECTOMY
ABDOMINAL MYOMECTOMY
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Case of Large fibroid- successful myomectomy
MRI showing Large fibroid
Morcellated pieces of fibroid
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WHAT ARE THE OPTIONS FOR MYOMECTOMY?
3. LAPAROSCOPIC MYOMECTOMY- surgery is done by
1cm holes in the abdomen. Long instruments are
introduced to complete the surgery 4.
HYSTEROSCOPIC MYOMECTOMY- submucous myoma is
removed using a teleoscopic instrument through
the vagina into the uterine cavity. 5. ROBOTIC
MYOMECTOMY- It is an advanced form of
Laparoscopic surgery
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WHY CHOOSE ROBOTIC MYOMECTOMY?
da Vinci Myomectomy A new category of
minimally invasive myomectomy, combines the best
of open and laparoscopic surgery. With the
assistance of Robotic Surgery-We can remove
uterine fibroids through small incisions with
unmatched precision and control Robot-assisted
surgery allows for superior visualization of the
fibroids and the surrounding tissues Provides Us
with an improved ability to suture the
uterusresulting in less overall blood loss
during the procedure compared to open or
laparoscopic surgery.
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Robotic Myomectomy-Advantages
Minimal scarring. Due to precise movement of
robotic arms the tisue trauma is less leading to
significantly less scarring Less blood loss.
Better dissection in the right planes and the
ability to suture more quickly, there is
significantly less intra-operative blood
loss Less post-operative pain. Less tissue trauma
causes less tissue inflammation hence less
pain. Faster recovery. Most patients are able to
resume normal activities within 2 weeks, compared
to 6 weeks for open surgery. Additionally,
patients can go home the same day of the
procedure Excellent suturing The excellent
precision and visualization offered by the da
Vinci Si enhances the surgeon's ability to suture
the uterus appropriately.
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Here are photos of ROBOTIC MYOMECTOMY done at
Apollo Hospitals, Hyderabad

• STEP 1. An incision is being made with the da
  Vinci robot over the fibroid on the uterine wall

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• STEP 2. The fibroid is grasped and dissected away
  from the surrounding myometrium.

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• STEP3. The dissection is complete and the The
  fibroid is almost free.

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STEP 4. The fibroid is put in an Endobag for
morcelation and removal
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STEP 5. The uterine margins from the area where
the myoma was removed is now being sutured in
layers.
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WHT ARE THE ALTERNATIVES TO MYOMECTOMY?

• Hysterectomy
• Uterine artery emboization
• MRgHIFU