PDF (5 MB) - Jurnalul de Chirurgie

350 Săceanu SM. et al.Jurnalul de Chirurgie (Iaşi), 2012, Vol. 8, Nr. 4procedures. In Table II we presented severaloperative data: mean surgical time, meantime for myomectomy and for uterine suture,number of myomas, overall myomas’volume and data about intraoperative bloodloss.Comparing the surgery time, wenoticed that the average time ofinterventions was similar: 111.8±6.13minutes for RALM and 103±7.27 minutesfor ML. In RALM group the time formyomectomy itself was 50.39±3.32 minutesand 22.37±1.03 minutes for the uterinesuture. In ML group, myomectomy lasted21.50±0.43 and uterine suture lasted21.05±1.68 minutes.We noticed that in the RALM group, ahigher number of myomas were extracted:2.26±0.26 myomas vs 1.8±0.25. Howeverthe overall myomas volume wassignificantly higher in ML group: 57.3±9.92cm 3 156.2±5.9 cm 3 ; P=0.0002.Blood loss was significantly lowerduring robotic-assisted laparoscopicmyomectomy: 140.7±10.67 mL vs267±22.95 mL; P < 10 -3 . In this way thepostoperative Hb was higher in RALMgroup (11.63±0.13 g/dL vs 10.73±0.24 g/dL;P=0.005); the difference betweenpreoperative and postoperative Hb (δ Hb)was lower in RALM group (0.51±0.06 g/dLvs 1.35±0.19 g/dL; P < 10 -3 ). We also noteda case of intraoperative hemorrhagecontrolled using Gelaspon ® patch.The postoperative hospital stay wasalso lower in RALM group: 2.05±0.04 daysvs 5.9±0.28 days; P < 0.0001.In RALM group, the overallpostoperative morbidity was 2.63% (onecase of urinary infection) and no procedurerelated postoperative morbidity wasreported.In ML group, the overall postoperativemorbidity rate was 3.16%: hyperthermiasyndromes and in only one case urinaryinfection was bacteriological confirmed.DISCUSSIONMyomectomy is one of the mostcommon interventions used in women ofchildbearing potential following a diagnosisof uterine fibroids who want to preservetheir fertility.Considering this reason, quality andresults of this technique must be flawlessand immediate and remote complicationsshould be minimal [2]. In this study weaimed to analyze the advantages andfeasibility of robotic myomectomycompared with standard treatment,laparotomy.The first aspect analyzed was theoverall surgical time and we noticed thatclassical intervention was, in average, only 8minutes shorter than the assisted roboticmyomectomy; however the duration ofmyomectomy itself doubled in the case ofcomputer assisted interventions.In conventional myomectomy, time islost with opening and closing of theperitoneal cavity and control of hemostasis.Longer duration for robotic assistedmyomectomy is due to the fact that patientsin that group presented a greater number offibroids than those in the laparotomymyomectomy group.Similar time between the twointerventions is explained by the fact thatduring a robotic assisted surgery, a longertime is attributed to the deployment andinstallation of the robot and changingforceps.In its analysis, Gargiulo et al, in 2012,showed a time of 195 minutes for a roboticmyomectomy [6]. Approximately the sameresults are reported by Barakat et al, with atime of 181 minutes for roboticmyomectomy and respectively, 126 minutesfor open myomectomy, [5].We believe that a difference of 8minutes during the whole intervention, and 1minute between the times for uterine sutureis minimal and demonstrates that roboticassisted surgery is not necessarily associatedwith an extended operating time, comparedto laparotomy.The number of extracted myomasduring laparotomy interventions was of 1.8,with a total volume of 156 cm 3 , and duringrobotics myomectomy 2.26, with a volume