PDF (5 MB) - Jurnalul de Chirurgie

348 Săceanu SM. et al.Jurnalul de Chirurgie (Iaşi), 2012, Vol. 8, Nr. 4occurs via open surgery is that enucleationof myomas, suturing and control ofhemostasis are very difficult to achieve bylaparoscopy [2].Myomectomy can be more easilyperformed by robotic assisted laparoscopicapproach, due to much better focus, a greaterprecision and ergonomic position thereforereducing also the fatigue [3]. Recently, itwas possible to add CT and MRI scans(augmented and virtual reality) duringsurgery for a better identification, locationand characteristics of myomas [4].Candidates for robotic assistedlaparoscopic myomectomy are patientspresenting [5]:1) symptomatic uterine fibroids in thecase of a patient who wants tomaintain fertility or preserve uterus;2) no more than 6 fibroids;3) a fibroid size not exceeding 10 cm.The objective of this study was toperform a comparative analysis betweenrobotic assisted laparoscopic and openapproach, for patients with uterineleiomyoma, in terms of feasibility andquality of operation (surgery time, numberand dimensions of extracted miomas,intraoperative blood loss).MATERIAL AND METHODWe conducted a retrospective study on166 patients diagnosed with uterine fibroidswho have received conservative surgery -myomectomy.We have removed from our studypatients treated with classical laparoscopicapproach because comparative studiesbetween laparotomy and laparoscopy orbetween laparoscopy and robotic approachhave already been carried out. In addition,most of the conservative treatment of uterinefibroid is performed through open surgery.Therefore, we decided to compare theclassic, most common, with the latestsurgical method that exists in the medicalworld, robotic assisted surgery.From the 166 patients included in thestudy, 38 cases (22.89%) were treated byrobotic assisted laparoscopic myomectomy(RALM), in 2008-2010, in the CisanelloClinic of Obstetrics and Gynecology, Pisa,Italy (Fig. 1, 2), and 128 patients (77,1%)underwent myomectomy by laparotomy(ML), during the same period, in the GeneralSurgery Clinic, Emergency Clinic HospitalCraiova, Romania (Fig. 3, 4).Fig. 1 Robotic assisted laparoscopic myomectomy– intraoperative view –Fig. 2 Robotic assisted laparoscopic myomectomy– uterine suture, intraoperative view –All patients gave their informedconsent about surgery and the use of data forscientific research.Both interventions were performedunder general anesthesia and endotrachealintubation. A bladder catheter was insertedin all patients, and a uterine manipulator wasused only in patients submitted to roboticassisted approach.Interventions were carried outaccording to the well codified techniques, inrobotic group the specimen being removedby morcellation.The following data were collected:age, body mass index (BMI), personalphysiological and disease antecedents,