LEARNING CURVE OF ROBOT-ASSISTED MYOMECTOMY

Abstract

Introduction. Robot-assisted myomectomy is the most modern types of surgical interventions for uterine myoma in patients of reproductive age. It benefit in simplicity of intracorporeal suturing and lack of laparoscopic myomectomy limitations. Of great scientific interest is the speed of mastering the method. We studied the learning curve of a robot-assisted myomectomy based on our own experience. Material and methods. A retrospective analysis of the results of 45 robot-assisted operations for uterine myomas from August 2016 to June 2017 was performed at the City Clinical Hospital named after S.I. Spasokukotskiy. All operations were performed by a single surgeon with extensive experience in laparoscopic surgery. The surgeon had no experience of robotic operations. Results. According to a retrospective analysis, there was stromg correlation between the acquired experience of robotic surgery and such indicators as the average duration of the operation, the time of thermal ischemia and the volume of blood loss. Conclusion. The learning curve of a robot-assisted myomectomy for an experienced laparoscopic surgeon improves to 15 operations. This experience is enough to perform operations with a minimum duration, volume of blood loss and complications.

Keywords

uterine myoma / robotic myomectomy / myomectomy

References

[1] Stewart E.A. Uterine fibroids. Lancet. 2001; 357(9252): 293-8. Doi: 10.1016/S0140-6736(00)03622-9

[2] Sunkara S.K., Khairy M., El-Toukhy T., Khalaf Y., Coomarasamy A. The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis. Hum. Reprod. 2010; 25(2): 418-29. Doi: 10.1093/humrep/dep396

[3] Ecker J.L., Foster J.T., Friedman A.J. Abdominal hysterectomy or abdominal myomectomy for symptomatic leiomyoma: a comparison of preoperative demography and postoperative morbidity. J. Gynecol. Surg.1995; 11(1):11-8. Doi: 10.1089/gyn.1995.11.11

[4] Dubuisson J., Botchorishvili R., Perrette S., Bourdel N., Jardon K., Rabischong B. et al. Incidence of intraabdominal adhesions in a continuous series of 1000 laparoscopic procedures. Am. J. Obstet. Gynecol. 2010; 203(2): e1-e3. Doi: 10.1016/j.ajog.2010.03.031

[5] Parker W.H., Einarsson J., Istre O., Dubuisson J.B. Risk factors for uterine rupture after laparoscopic myomectomy. J. Minim. Invasive Gynecol. 2010; 17(5): 551-4. Doi: 10.1016/j.jmig.2010.04.015

[6] Falcone T., Bedaiwy M.A. Minimally invasive management of uterine fibroids. Curr. Opin. Obstet. Gynecol. 2002; 14: 401-7. Doi: 10.1097/00001703-200208000-00007

[7] Daraï E., Dechaud H., Benifla J.L., Renolleau C., Panel P., Madelenat P. Fertility after laparoscopic myomectomy: preliminary results. Hum. Reprod. 1997; 12: 1931-4. Doi: 10.1093/humrep/12.9.1931

[8] Roopnarinesingh S., Suratsingh J., Roopnarinesingh A. The obstetric outcome of patients with previous myomectomy or hysterotomy. West Indian Med. J. 1985; 34(1): 59-62.

[9] Dubuisson J.B., Fauconnier A., Deffarges J.V., Norgaard C., Kreiker G., Chapron C. Pregnancy outcome and deliveries following laparoscopic myomectomy. Hum. Reprod. 2000; 15(4): 869-73. Doi: 10.1093/humrep/15.4.869

[10] Braumann C., Jacobi C.A., Menenakos C., Ismail M., Rueckert J.C., Mueller J.M. Robotic-assisted laparoscopic and thoracoscopic surgery with the da Vinci system: a 4-year experience in a single institution. Surg. Laparosc. Endosc. Percutan Tech. 2008; 18(3): 260-6. Doi: 10.1097/SLE.0b013e31816f85e5

[11] Advincula A.P., Song A., Burke W., Reynolds R.K. Preliminary experience with robotic-assisted laparoscopic myomectomy. J. Am. Assoc. Gynecol. Laparosc. 2004; 11(4): 511-8. Doi: 10.1016/S1074-3804(05)60085-0

[12] Advincula A.P., Xu X., Goudeau S., IV, Ransom S.B. Robotic assisted laparoscopic myomectomy versus abdominal myomectomy: a comparison of short term surgical outcomes and immediate costs. J. Minim. Invasiv. Gynecol. 2007; 14: 698-705. Doi: 10.1016/j.jmig.2007.06.008

[13] Nezhat C., Lavie O., Hsu S., Watson J., Barnett O., Lemyre M. Robotic assisted laparoscopic myomectomy compared with standard laparoscopic myomectomy - a retrospective matched control study. Fertil. Steril. 2009; 91(2): 556-9. doi: 10.1016/j.fertnstert.2007.11.092

[14] Bedient C.E., Magrina J.F., Hsu S., Watson J., Barnett O., Lemyre M. Comparison of robotic and laparoscopic myomectomy. Am. J. Obstet. Gynecol. 2009; 201(6): e1-566. doi: 10.1016/j.ajog.2009.05.049

[15] Pundir J., Pundir V., Walavalkar R., Omanwa K., Lancaster G., Kayani S. Robotic-assisted laparoscopic vs. abdominal and laparoscopic myomectomy: systematic review and meta-analysis. J. Minim. Invasive Gynecol. 2013; 20(3): 335-45. Doi: 10.1016/j.jmig.2012.12.010

[16] Barakat E., Bedaiwy A., Zimberg S., Nutter B., Nosseir M., Falcone T. Robotic assisted, laparoscopic, and abdominal myomectomy: a comparison of surgical outcomes. Obstet. Gynecol. 2011; 117: 256-65. doi: 10.1097/AOG.0b013e318207854f

[17] Ascher-Walsh C., Capes T. Robot-assisted laparoscopic myomectomy is an improvement over laparotomy in women with a limited number of myomas. J. Minim. Invasive Gynecol. 2010; 17(3): 306-10. 10.1016/j.jmig.2010.01.011

[18] Lönnerfors C., Persson J. Pregnancy following robot-assisted laparoscopic myomectomy in women with deep intramural myomas. Acta Obstet. Gynecol. Scand. 2011; 90(9): 972-7. doi: 10.1111/j.1600-0412.2011.01207.x

[19] Cheng H.Y., Chen Y.J., Wang P.H., Tsai H.W., Chang Y.H., Twu N.F., et al. Robotic-assisted laparoscopic complex myomectomy: a single medical center’s experience. Taiwan J. Obstet. Gynecol. 2015; 54(1): 39-42. doi: 10.1016/j.tjog.2014.11.004

[20] Lenihan J.P. Jr, Kovanda C., Seshadri-Kreaden U. What is the learning curve for robotic assisted gynecologic surgery? J. Minim. Invasive Gynecol. 2008;15(5): 589-94.

[21] Sunkara S.K., Khairy M., El-Toukhy T., Khalaf Y., Coomarasamy A. The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis. Hum. Reprod. 2010; 25(2): 418-29. doi: 10.1093/humrep/dep396

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