Minimally invasive myomectomy, using several small entry points in the abdomen instead of an incision has been offered at Brigham and Women’s Hospital for almost two decades as an alternative to abdominal myomectomy. Minimally invasive myomectomy, which uses conventional or robot-assisted laparoscopy, allows the operation to be performed in day surgery, with less surgical risks, less postoperative pain and much quicker return to normal activities.
In a new publication, researchers from Brigham and Women’s Hospital (BWH) report the first cases of robotic single-site (RSS) myomectomies with the use of the da Vinci Single-Site platform, a new instrumentation attached to the da Vinci robot. Using this system, the surgeons are able to remove fibroids through one small incision in the belly button, resulting in a minimally invasive surgical procedure with no visible scar. This report is published in Fertility and Sterility, the journal of the American Society for Reproductive Medicine, on March 16, 2015.
“In a first-of-its-kind application, we show that use of the da Vinci Single-Site robotic platform for myomectomy is a feasible and reproducible procedure with many prospective benefits, both clinical and cosmetic,” explained Antonio Gargiulo, MD, medical director of the Center for Robotic Surgery at BWH and senior author of this study.
Gargiulo and colleagues document four cases in which patients with symptomatic uterine fibroids underwent RSS myomectomies at BWH’s Center for Infertility and Reproductive Surgery during November and December of 2014. The main outcome measure was safety and reproducibility of RSS myomectomy.
In each case, surgeons successfully used the new instrumentation to remove the fibroids through the singe-site procedure that lasted, on average, 210 minutes. Researchers document no operative or post operative complications, and no instrument failures. Two patients were discharged on the day of surgery and two were discharged after one overnight observation stay.
“These patients were highly satisfied with the obvious cosmetic outcome: a single incision hidden in the belly button,” said Gargiulo. “Beyond the cosmetic benefits, laparoscopic single-site surgery has been associated with decreased pain following the procedure, lower risk for hernias and a shorter recovery time.”
Robotic single-site technology for the da Vinci Surgical System was approved by the FDA in 2013 for hysterectomy and adnexal surgery. However, given the absence of wristed instrumentation in the original da Vinci Single-Site release, suture-intensive procedures, like myomectomy, had never been performed until now. Based on recently available wristed instrumentation, BWH was able to perform and report this original technique for RSS myomectomy.
Innovation involving the da Vinci Surgical System has a history at BWH where Gargiulo and his colleagues were the first in the nation to create and adopt a stringent, hospital-wide and industry-independent, training and credentialing process for specialists wishing to practice computer-assisted surgery with the da Vinci Surgical System. BWH also utilizes a state-of-the-art simulation unit entirely dedicated to surgeons’ training on the system.
Researchers note that limitations of this study include the small number of cases described, and that larger, prospective studies with long term follow-up are necessary to validate the best indications and the safety profile of RSS myomectomy.
Brigham and Women’s Hospital