Choi Eun Ji, Rho A Mi, Lee Sa Ra, Jeong Kyungah, Moon Hye-Sung
Department of Obstetrics and Gynecology, Robot Surgery Center, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
Department of Obstetrics and Gynecology, Robot Surgery Center, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
J Minim Invasive Gynecol. 2017 May-Jun;24(4):632-639. doi: 10.1016/j.jmig.2017.02.003. Epub 2017 Feb 12.
To report 61 consecutive cases of successful robotic single-site myomectomy (RSSM), and to evaluate the feasibility and safety of RSSM.
Retrospective analysis of 61 cases involving RSSM (Canadian Task Force classification III).
Department of Obstetrics and Gynecology, College of Medicine, Robot Surgery Center, Ewha Womans University, Seoul, Republic of Korea.
Sixty-one patients who underwent RSSM performed by 3 gynecologic surgeons at Ewha Womans University between December 2014 and May 2016.
We analyzed the patients' baseline characteristics and surgical variables and the trends in operation-related variables according to surgeon's level of experience with RSSM.
There were no cases of conversion to laparotomy or robotic multisite myomectomy. RSSM was successful for multiple uterine myomas up to 12 in number and for large myomas up to 12.8 cm in longest diameter. In terms of myoma location, RSSM was successful for all types of myomas, including subserosal, intramural, and intraligamentary. The mean docking time was 5.45 ± 2.84 minutes (2.0∼12.0 minutes), mean total operation time was 135.98 ± 59.62 minutes (60∼295 minutes), mean estimated blood loss was 182.62 ± 153.02 mL (10∼600 mL), and mean skin incision length was 2.70 ± 0.19 cm (2.4∼3.10 cm). The mean time to postoperative gas passage was 28.71 ± 12.99 hours (3.33∼76.50 hours), and the mean duration of hospitalization was 4.21 ± 0.84 days (3∼6 days). No patient required additional analgesics other than applied intravenous patient-controlled analgesia. The mean change in hemoglobin level was 2.43 ± 0.87 g/dL, and the incidence of postoperative anemia requiring blood transfusion was only 3.3% (2 cases). No intraoperative or perioperative complications were noted.
RSSM is a feasible and safe procedure even in cases large, multiple, and intramural type myomas. Therefore, this option could be extended to appropriately selected patients.
报告连续61例机器人单孔子宫肌瘤切除术（RSSM）成功的病例，并评估RSSM的可行性和安全性。
对61例RSSM病例进行回顾性分析（加拿大工作组分类III级）。
韩国首尔梨花女子大学医学院妇产科、机器人手术中心。
2014年12月至2016年5月间，61例在梨花女子大学由3名妇科外科医生实施RSSM的患者。
我们分析了患者的基线特征和手术变量，以及根据外科医生RSSM经验水平的手术相关变量趋势。
无转为开腹手术或机器人多孔子宫肌瘤切除术的病例。RSSM对多达12个的多发性子宫肌瘤以及最长直径达12.8 cm的大肌瘤均成功。就肌瘤位置而言，RSSM对所有类型的肌瘤均成功，包括浆膜下、肌壁间和阔韧带内肌瘤。平均对接时间为5.45±2.84分钟（2.0至12.0分钟），平均总手术时间为135.98±59.62分钟（60至295分钟），平均估计失血量为182.62±153.02 mL（10至600 mL），平均皮肤切口长度为2.70±0.19 cm（2.4至3.10 cm）。术后平均排气时间为28.71±12.99小时（3.33至76.50小时），平均住院时间为4.21±0.84天（3至6天）。除静脉自控镇痛外，无患者需要额外镇痛。血红蛋白水平平均变化为2.43±0.87 g/dL，术后需要输血的贫血发生率仅为3.3%（2例）。未观察到术中或围手术期并发症。
即使对于大的、多发的和肌壁间型肌瘤病例，RSSM也是一种可行且安全的手术。因此，该选择可扩展至适当选择的患者。
