ROBOTIC MYOMECTOMY Dr Rooma Sinha, MD, DNB Senior Consultant Gynecologist & Laparoscopic Surgeon Apollo Health City; HYDERABAD www.gynecologyhyderabad.com, drroomasinha@hotmail.com 9550326662; 9849008180

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

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.

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

Case of Large fibroid- successful myomectomy MRI showing Large fibroid Morcellated pieces of fibroid

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

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 uterus—resulting in less overall blood loss during the procedure compared to open or laparoscopic surgery.

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.

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

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

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

STEP 4. The fibroid is put in an Endobag for morcelation and removal

STEP 5. The uterine margins from the area where the myoma was removed is now being sutured in layers.

WHT ARE THE ALTERNATIVES TO MYOMECTOMY? Hysterectomy Uterine artery emboization MRgHIFU