Ewha Med J.  2019 Apr;42(2):20-23. 10.12771/emj.2019.42.2.20.

Lack of Haptic Feedback Is Replaced by More Developed Visual Sense during Robotic Myomectomy

Affiliations
  • 1Department of Obstetrics and Gynecology, Gynecologic Oncology Branch & Robot Surgery Center, Ewha Womans University College of Medicine, Seoul, Korea. mhsmhs@ewha.ac.kr

Abstract

In the reproductive age, many women have several uterine myomas and present with abnormal uterine bleeding, dysmenorrhea, and occasionally infertility. There are three surgical approaches to perform myomectomy, including robotic-assisted, laparoscopic, and abdominal myomectomy. Compared to laparoscopic procedures, robotic myomectomy allows free approach of myoma bases using fine instruments and endoscopes. Fine uterine wall sutures can be performed layer-by-layer with robots. However, robotic surgery is difficult to perform because there is no sense of touch during the operation. We report two clinical myomectomy cases with replaced lack of haptic feedback during robot surgery. The patients received robotic myomectomy with/without right ovarian cystectomy and adhesiolysis. Sixty-five leiomyomas were removed in case 1. Forty-six leiomyomas were removed in case 2. Lack of haptic feedback is replaced by more developed visual sense during robot myomectomy of multiple tiny intramural myomas, and robotic surgery can be performed much more effectively even in complicated cases.

Keyword

Uterine myomectomy; Myoma; Robotic surgical procedures

MeSH Terms

Cystectomy
Dysmenorrhea
Endoscopes
Female
Humans
Infertility
Leiomyoma
Myoma
Robotic Surgical Procedures
Sutures
Uterine Hemorrhage
Uterine Myomectomy

Figure

  • Fig. 1 Radiologic imaging and surgical findings of case 1. (A) Sagittal view of pelvis MRI finding in case 1 with measured tiny intramural myoma nodules. (B) Other sagittal view of pelvis MRI finding in case 1 with measured tiny intramural myoma nodules. (C) Deep seated tiny myoma nodules shown during robotic myomectomy. The robotic bipolar forceps tip is shorter than 1.5 cm in length and longer than the longest diameter of tiny myoma nodules. (D) Deep seated tiny myoma nodules were shown during robotic myomectomy. The longest diameter of myoma nodule is similar to the 1.2-cm length of robotic metzenbaum scissor's tip. (E) All myoma specimens in case 1 removed with various sizes.

  • Fig. 2 Radiologic imaging and surgical findings of case 2. (A) Sagittal pelvis MRI finding of case 2 with measured tiny myoma nodules in anterior wall of uterus. (B) Other sagittal view of pelvis MRI finding in case 2 with tiny intramural myoma nodules in posterior wall of uterus. (C) All removed myoma specimens in case 2.


Reference

1. Shue S, Radeva M, Falcone T. Comparison of long-term fertility outcomes after myomectomy: relationship with number of myomas removed. J Minim Invasive Gynecol. 2018; 25:1002–1008.
Article
2. Flyckt R, Soto E, Nutter B, Falcone T. Comparison of long-term fertility and bleeding outcomes after robotic-assisted, laparoscopic, and abdominal myomectomy. Obstet Gynecol Int. 2016; 2016:2789201.
Article
3. Lenihan JP Jr, Kovanda C, Seshadri-Kreaden U. What is the learning curve for robotic assisted gynecologic surgery? J Minim Invasive Gynecol. 2008; 15:589–594.
Article
4. Gargiulo AR, Srouji SS, Missmer SA, Correia KF, Vellinga TT, Einarsson JI. Robot-assisted laparoscopic myomectomy compared with standard laparoscopic myomectomy. Obstet Gynecol. 2012; 120:284–291.
Article
5. Wijesinghe P, Sampson DD, Kennedy BF. Computational optical palpation: a finite-element approach to micro-scale tactile imaging using a compliant sensor. J R Soc Interface. 2017; 14:20160878.
Article
6. Sikora-Szczesniak DL. Prevalence of cellular leiomyoma and partially cellular leiomyoma in postoperative samples: analysis of 384 cases. Ginekol Pol. 2016; 87:609–616.
7. Guan R, Zheng W, Xu M. A retrospective analysis of the clinicopathologic characteristics of uterine cellular leiomyomas in China. Int J Gynaecol Obstet. 2012; 118:52–55.
Article
8. Shiota M, Kotani Y, Umemoto M, Tobiume T, Hoshiai H. Recurrence of uterine myoma after laparoscopic myomectomy: what are the risk factors? Gynecol Minim Invasive Ther. 2012; 1:34–36.
Article
9. Lonnerfors C, Persson J. Pregnancy following robot-assisted laparoscopic myomectomy in women with deep intramural myomas. Acta Obstet Gynecol Scand. 2011; 90:972–977.
10. Bedient CE, Magrina JF, Noble BN, Kho RM. Comparison of robotic and laparoscopic myomectomy. Am J Obstet Gynecol. 2009; 201:566.e1–566.e5.
Article
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