Advertisement

Comparison between single-site and multiport robot-assisted myomectomy

  • Gaby N. MoawadEmail author
  • Paul TyanEmail author
  • Jiheum Paek
  • Erryn E. Tappy
  • Daniel Park
  • Souzanna Choussein
  • Serene S. Srouji
  • Antonio Gargiulo
Original Article

Abstract

Minimizing the number of port incisions during minimally invasive surgery is associated with improved outcomes and patient satisfaction. We designed this work to study the perioperative outcomes of robotic single-site myomectomy (RSSM) in comparison to robotic multiport myomectomy (RMM) in a certain subset of patients. The design of the study is a multicenter retrospective analysis (Canadian Task Force classification III). The setting was three university hospitals. Eighty patients with symptomatic uterine fibroids undergoing robot-assisted single-site myomectomy were selected for the study. These 80 consecutive RSSM patients were matched at the uterine fibroid tumor burden level with 95 consecutive RMM patients performed at the same institutions, by the same surgeons, within a similar time frame. The main outcome measures were estimated blood loss (EBL), operative time, overnight admission, and post-operative complications. Of the 175 women, 95 (54.2%) underwent RMM and 80 (45.7%) underwent RSSM. Single-site vs. multiport patient demographics differed significantly in mean age (39.1 vs. 35.6, p < 0.001), and BMI (25.3 vs. 27.5, p < 0.04). Pre-operative MRI fibroid characteristics were matched between the two cohorts. Fibroid size on imaging (5.8 cm vs. 5.9 cm, p = 0.4) and the number of fibroids removed (2.5 vs. 2.3, p = 0.08) were similar between the two groups. After adjustment for multiple covariates with regression models, single-site myomectomy and multiport myomectomy has comparable EBL (83.3 mL vs. 109.2 mL, p = 0.34), operative time (162.4 min vs. 162.4 min, p = 0.99), overnight admission (OR = 1.54, p = 0.44) and a post-operative complication (OR = 1.3, p = 0.78). In selected patients, robotic single-site myomectomy is equivalent to its multiport counterpart. Both surgical approaches are associated with low rates of intra-operative and post-operative complications.

Keywords

Robotic myomectomy Single-site surgery Minimally invasive myomectomy Single-site myomectomy 

Abbreviations

RSSS

Robot-assisted single-site myomectomy

RMM

Robot-assisted multiport myomectomy

EBL

Estimated blood loss

MRI

Magnetic resonance imaging

BMI

Body mass index

SD

Standard deviation

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

Doctors Tyan, Paek, Tappy, Park, Chousein, Srouji, and Gargiulo declare that they have no conflict of interest. Dr. Moawad is a speaker for Intuitive Surgical.

References

  1. 1.
    Okolo S (2008) Incidence, aetiology and epidemiology of uterine fibroids. Best Pract Res Clin Obstet Gynaecol 22(4):571–588CrossRefGoogle Scholar
  2. 2.
    Merrill RM, Layman AB, Oderda G, Asche C (2008) Risk estimates of hysterectomy and selected conditions commonly treated with hysterectomy. Ann Epidemiol 18(3):253–260CrossRefGoogle Scholar
  3. 3.
    Falcone T, Parker WH (2013) Surgical management of leiomyomas for fertility or uterine preservation. Obstet Gynecol 121(4):856–868CrossRefGoogle Scholar
  4. 4.
    Barakat EE, Bedaiwy MA, Zimberg S, Nutter B, Nosseir M, Falcone T (2011) Robotic-assisted, laparoscopic, and abdominal myomectomy: a comparison of surgical outcomes. Obstet Gynecol 117(2 Pt 1):256–265CrossRefGoogle Scholar
  5. 5.
    Holzer A, Jirecek ST, Illievich UM, Huber J, Wenzl RJ (2006) Laparoscopic versus open myomectomy: a double-blind study to evaluate postoperative pain. Anesth Analg 102(5):1480–1484CrossRefGoogle Scholar
  6. 6.
    Jin C, Hu Y, Chen XC, Zheng FY, Lin F, Zhou K et al (2009) Laparoscopic versus open myomectomy–a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 145(1):14–21CrossRefGoogle Scholar
  7. 7.
    Buckley VA, Nesbitt-Hawes EM, Atkinson P, Won HR, Deans R, Burton A et al (2015) Laparoscopic myomectomy: clinical outcomes and comparative evidence. J Minim Invasive Gynecol 22(1):11–25CrossRefGoogle Scholar
  8. 8.
    Pundir J, Pundir V, Walavalkar R, Omanwa K, Lancaster G, Kayani S (2013) Robotic-assisted laparoscopic vs abdominal and laparoscopic myomectomy: systematic review and meta-analysis. J Minim Invasive Gynecol 20(3):335–345CrossRefGoogle Scholar
  9. 9.
    Choussein S, Srouji SS, Farland LV et al (2017) Robotic assistance confers ambidexterity to laparoscopic surgeons. J Minim Invasive Gynecol 25(1):76–83CrossRefGoogle Scholar
  10. 10.
    Sinno AK. Fader AN (2014) Robotic-assisted surgery in gynecologic oncology. Fertil Steril 102:922–932CrossRefGoogle Scholar
  11. 11.
    Canadian Medical Association Journal (2017). Retrieved September 07. From http://www.cmaj.ca/
  12. 12.
    Iavazzo C. Mamais I. Gkegkes ID (2016) Robotic assisted vs laparoscopic and/or open myomectomy: systematic review and meta-analysis of the clinical evidence. Arch Gynecol Obstet 294(1):5–17CrossRefGoogle Scholar
  13. 13.
    Goebel K, Goldberg JM (2014) Women’s preference of cosmetic results after gynecologic surgery. J Minim Invasive Gynecol 21(1):64–67CrossRefGoogle Scholar
  14. 14.
    Yeung PP Jr, Bolden CR, Westreich D, Sobolewski C (2013) Patient preferences of cosmesis for abdominal incisions in gynecologic surgery. J Minim Invasive Gynecol 20(1):79–84CrossRefGoogle Scholar
  15. 15.
    Fanfani F, Monterossi G, Fagotti A, Scambia G (2014) Laparoendoscopic single-site hysterectomy: is it safe and feasible? Curr Opin Obstet Gynecol 26:275–280CrossRefGoogle Scholar
  16. 16.
    Fagotti A, Boruta DM IInd, Scambia G, Fanfani F, Paglia A, Escobar PF (2012) First 100 early endometrial cancer cases treated with laparoendoscopic single-site surgery: a multicentric retrospective study. Am J Obstet Gynecol 206:353.e1–353.e6CrossRefGoogle Scholar
  17. 17.
    Cela V, Freschi L, Simi G, Ruggiero M, Tana R, Pluchino N (2013) Robotic single-site hysterectomy: feasibility, learning curve and surgical outcome. Surg Endosc 27:2638–2643. 11CrossRefGoogle Scholar
  18. 18.
    Bogliolo S, Ferrero S, Cassani C et al (2016) Single-site versus multiport robotic hysterectomy in benign gynecologic diseases: a retrospective evaluation of surgical outcomes and cost analysis. J Minim Invasive Gynecol 23:603–609CrossRefGoogle Scholar
  19. 19.
    Yim GW, Jung YW, Paek J, Lee SH, Kwon HY, Nam EJ et al (2010) Transumbilical single-port access versus conventional total laparoscopic hysterectomy: surgical outcomes. Am J Obstet Gynecol 203(1):26 e1–e6CrossRefGoogle Scholar
  20. 20.
    Kim TJ, Lee YY, Cha HH, Kim CJ, Choi CH, Lee JW et al (2010) Single-port-access laparoscopic-assisted vaginal hysterectomy versus conventional laparoscopic-assisted vaginal hysterectomy: a comparison of perioperative outcomes. Surg Endosc 24(9):2248–2252CrossRefGoogle Scholar
  21. 21.
    Yoshiki N, Okawa T, Kubota T (2011) Single-incision laparoscopic myomectomy with intracorporeal suturing. Fertil Steril 95(7):2426–2428CrossRefGoogle Scholar
  22. 22.
    Choi CH, Kim TH, Kim SH, Choi JK, Park JY, Yoon A et al (2014) Surgical outcomes of a new approach to laparoscopic myomectomy: single-port and modified suture technique. J Minim Invasive Gynecol 21(4):580–585CrossRefGoogle Scholar
  23. 23.
    Eisenberg D, Vidovszky TJ, Lau J, Guiroy B, Rivas H (2013) Comparison of robotic and laparoendoscopic single-site surgery systems in a suturing and knot tying task. Surg Endosc 27(9):3182–3186CrossRefGoogle Scholar
  24. 24.
    Angus AA, Sahi SL, McIntosh BB (2014) Learning curve and early clinical outcomes for a robotic surgery novice performing robotic single site cholecystectomy. Int J Med Robot 10(2):203–207CrossRefGoogle Scholar
  25. 25.
    Truong M, Kim JH, Scheib S, Patzkowsky K (2016) Advantages of robotics in benign gynecologic surgery. Curr Opin Obstet Gynecol 28(4):304–310CrossRefGoogle Scholar
  26. 26.
    Moawad GN, Samuel D, Abi khalil ED (2016) Tips and tricks: single-site robotic-assisted myomectomy. J Minim Invasive Gynecol 23(6):861CrossRefGoogle Scholar
  27. 27.
    Gargiulo AR, Lewis EI, Kaser DJ, Srouji SS (2015) Robotic single-site myomectomy: a step-by-step tutorial. J Minim Invasive Gynecol 22(6S):S135CrossRefGoogle Scholar
  28. 28.
    Munro MG, Critchley HO, Fraser IS (2011) The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril 95(7):2204-8, 2208.e1-3CrossRefGoogle Scholar
  29. 29.
    Kroh M, El-Hayek K, Rosenblatt S, Chand B, Escobar P, Kaouk J et al (2011) First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci Single-Site platform. Surg Endosc 25(11):3566–3573CrossRefGoogle Scholar
  30. 30.
    Gargiulo AR, Bailey AP, Srouji SS (2013) Robot-assisted single-incision laparoscopic myomectomy: initial report and technique. J Robot Surg 7(2):137–142CrossRefGoogle Scholar
  31. 31.
    Lewis EI, Srouji SS, Gargiulo AR (2015) Robotic single-site myomectomy: initial report and technique. Fertil Steril 103(5):1370–1377 e1CrossRefGoogle Scholar
  32. 32.
    Nam SH, Paek J, Choi C, Nam SH, Kim WY (2017) A comparison between reduced-port robotic surgery and multiport robot-assisted laparoscopy for myomectomy. Eur J Obstet Gynecol Reprod Biol 213:53–57CrossRefGoogle Scholar
  33. 33.
    Sendag F, Akdemir A, Zeybek B, Ozdemir A, Gunusen I, Oztekin MK (2014) Single-site robotic total hysterectomy: standardization of technique and surgical outcomes. J Minim Invasive Gynecol 21(4):689–694CrossRefGoogle Scholar
  34. 34.
    Scheib SA, Fader AN (2015) Gynecologic robotic laparoendoscopic single-site surgery: prospective analysis of feasibility, safety, and technique. Am J Obstet Gynecol 212(2):179 e1–e8CrossRefGoogle Scholar
  35. 35.
    Gargiulo AR, Choussein S, Srouji SS, Cedo LE, Escobar PF (2017) Coaxial robot-assisted laparoendoscopic single-site myomectomy. J Robot Surg 11(1):27–35CrossRefGoogle Scholar
  36. 36.
    Akdemir A, Zeybek B, Ozgurel B, Oztekin MK, Sendag F (2015) Learning curve analysis of intracorporeal cuff suturing during robotic single-site total hysterectomy. J Minim Invasive Gynecol 22(3):384–389CrossRefGoogle Scholar
  37. 37.
    Gunderson CC, Knight J, Ybanez-Morano J, Ritter C, Escobar PF, Ibeanu O et al (2012) The risk of umbilical hernia and other complications with laparoendoscopic single-site surgery. J Minim Invasive Gynecol 19(1):40–45CrossRefGoogle Scholar
  38. 38.
    FDA Safety Communication. Updated laparoscopic uterine power morcellation in hysterectomy and myomectomy. Available from https://www.fda.gov/medicaldevices/safety/alertsandnotices/ucm424443.htm

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and GynecologyGeorge Washington University HospitalWashingtonUSA
  2. 2.Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and GynecologyUniversity of North Carolina School of MedicineChapel HillUSA
  3. 3.Department of Obstetrics and Gynecology, Gynecologic Cancer CenterAjou University Medical CenterSuwonRepublic of Korea
  4. 4.Department of Epidemiology and Biostatistics, Milken Institute School of Public HealthGeorge Washington UniversityWashingtonUSA
  5. 5.Division of Reproductive Endocrinology and Infertility, and Reproductive Biology, Department of Obstetrics, GynecologyHarvard Medical School, Brigham and Women’s HospitalBostonUSA

Personalised recommendations