Kim Ji-Hye, Lee Eun-Ju
Department of Obstetrics and Gynecology, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Gynecol Obstet Invest. 2022;87(1):70-78. doi: 10.1159/000523812. Epub 2022 Mar 1.
Despite the advantages of robotic technology, single-site robotic myomectomy (SSRM) without an accessory instrument is limited by a restricted range of motion, weaker suturing of a thick myometrium, and non-articulating instruments. We present our novel gradual turning out method (GTOM) of SSRM and our assessment of its feasibility and safety by comparing its perioperative outcomes with those of two-port laparoscopic myomectomy (LM).
A retrospective cohort case-control study was carried out.
This study included consecutive 46 patients who underwent SSRM for intramural myomas larger than 7 cm, from 2016 to 2019. Subsequently, 46 patients who underwent LM were selected by 1:1 propensity score matching by controlling for age, body mass index, myoma number, myoma diameter, and the presence of sexual intercourse. The perioperative outcomes of the two groups were compared using a Mann-Whitney U test and Fisher's exact test. The effect of covariates on operation time was analyzed using univariable and multivariable linear regression.
SSRM was performed successfully with GTOM for myomas of up to 14 cm in the longest diameter, without conversion to laparotomy and intraoperative injuries. No differences between the groups were found in length of hospital stay, estimated blood loss, hemoglobin level decrease, transfusion rate, and postoperative pain, but operative time was significantly longer in the SSRM group than in the LM group (p < 0.001). Larger myomas, location of the lower segment, and the operation method of SSRM were significantly associated with a longer operation time. Whereas operation time for myomas located at the anterior wall, singleton myomas, and myomas <10 cm was significantly longer in the SSRM group than in the LM group, that for myomas at the posterior or lateral side of the uterus, multiple myomas, and myomas ≥10 cm did not differ significantly between the groups, indicating the advantage of SSRM for difficult myomectomy.
Retrospective nature of the study and limitation to a single-center study are the limitations of the study.
Despite the lack of an accessory instrument, SSRM using the GOTM was feasible and safe as it yielded similar perioperative outcomes to those of LM.
尽管机器人技术具有诸多优势，但无辅助器械的单孔机器人子宫肌瘤切除术（SSRM）受到运动范围受限、子宫肌层较厚时缝合能力较弱以及非关节式器械的限制。我们介绍了我们新颖的SSRM逐步转出法（GTOM），并通过比较其围手术期结果与双孔腹腔镜子宫肌瘤切除术（LM）的结果，对其可行性和安全性进行评估。
进行了一项回顾性队列病例对照研究。
本研究纳入了2016年至2019年连续46例因壁间肌瘤大于7 cm而接受SSRM的患者。随后，通过1:1倾向评分匹配，根据年龄、体重指数、肌瘤数量、肌瘤直径和性生活情况，选择了46例接受LM的患者。使用曼-惠特尼U检验和费舍尔精确检验比较两组的围手术期结果。使用单变量和多变量线性回归分析协变量对手术时间的影响。
采用GTOM成功实施了SSRM，治疗了最长直径达14 cm的肌瘤，未转为开腹手术且无术中损伤。两组在住院时间、估计失血量、血红蛋白水平下降、输血率和术后疼痛方面未发现差异，但SSRM组的手术时间明显长于LM组（p < 0.001）。较大的肌瘤、下段位置以及SSRM的手术方式与较长的手术时间显著相关。虽然位于前壁的肌瘤、单发肌瘤和直径<10 cm的肌瘤，SSRM组的手术时间明显长于LM组，但子宫后壁或侧壁的肌瘤、多发肌瘤和直径≥10 cm的肌瘤，两组之间无显著差异，这表明SSRM在困难子宫肌瘤切除术中的优势。
本研究的回顾性性质以及单中心研究的局限性是本研究的不足之处。
尽管缺乏辅助器械，但使用GOTM的SSRM是可行且安全的，因为其围手术期结果与LM相似。
