Myomectomy is the surgical removal of uterine fibroids. It is a treatment option for women who would like to keep their uterus for future childbearing or other reasons.
Myomectomy in many cases is a much more complicated procedure than a hysterectomy. For each fibroid removed, a small incision is made in the uterus, the fibroid removed, and then the incision is sutured back together. Many women have multiple fibroids, which require multiple incisions.
In the videos below, Dr. Heath Miller describes the robotic myomectomy procedure and its benefits.
Robotic procedures are performed in an operating room, with a specially trained surgical staff. Patients are under general anesthesia, and constantly monitored by an anesthesiologist.
During the procedure:
- The surgeon makes three to five incisions in the abdomen, each five to 12 millimeters long
- The abdomen is inflated with carbon dioxide gas to allow room for the surgeon to work
- Specially designed surgical instruments and a small camera are attached to robotic arms and precisely inserted through the incisions
- The surgeon then sits at a nearby console, controlling every movement of the surgical instruments
For each fibroid:
- The surgeon makes an incision in the uterine wall to expose the fibroid
- The fibroid is carefully separated from the wall of the uterus
- Once separated, it is removed through one of the abdominal incisions
- The uterus is sutured in that spot in multiple layers
Large fibroids are removed in pieces with specialized instrumentation. When all fibroids have been removed, the surgical instruments are removed and the abdominal incisions are sutured closed.
Traditional myomectomy calls for cutting a large incision in the abdomen to access the uterus — as is done for a cesarean section.
Laparoscopic myomectomy is a minimally invasive method, but more complicated and difficult to learn to perform because the tools are rigid.
Robotic myomectomy is an enhancement over conventional laparoscopy techniques. The robotic tools allow the surgeon greater precision of movement. The field of vision is also magnified and shown in 3-D.
Swedish has been using the daVinci Surgical System to perform myomectomies since 2005. It is an ideal tool for surgeons performing myomectomies. That's because:
- The ability to see in 3-D graphics and with significant magnification gives the surgeon a crystal clear view of the tissue layers involved during dissection
- The robotic "wristed" instrumentation allows the surgeon to suture precisely
- The enhanced dexterity in suturing helps ensure that the integrity of the uterine wall is maintained so the uterus can safely support a pregnancy
For patients, the benefits of robotic myomectomy include:
- Patients typically go home the next day
- Moderate discomfort usually subsides in three to five days
- Most people return to work within a week or two
- Scars from tiny incisions are cosmetically superior
In comparison, the open procedure with its large incision typically requires three to four days in the hospital and four to six weeks to recover.
All surgeries involve some degree of risk, and discussing this with your doctor is an important part of preparing for any surgery.
Complications from robotic myomectomy are uncommon.
In comparison, because of the large incision, the risks from an open myomectomy include: an increased risk of post-surgical infection, blood clots in the legs (deep-vein thrombosis) and scar tissue that may interfere with fertility.
Robotic surgical systems are now widely available. That does not mean every surgeon has the experience to perform robotic surgery with good outcomes.
Many of our gynecological surgeons are among the most experienced in the country. They have been performing gynecological surgeries robotically since the FDA approved the daVinci system for this use in 2005.
When you interview surgeons you are considering, be sure to ask:
- How long has robotic surgery been available at the hospital?
- Does it have a surgical suite dedicated to robotic surgery?
- How many robotic surgeries have been done at the hospital?
- How long has the surgeon been doing robotic myomectomies?
Swedish is committed to developing procedures that provide better outcomes for our patients. We are a regional center for performing – and teaching – robotic surgery. More than 4,000 robotic procedures have been performed here to date, and our surgeons publish and lecture widely.