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Robotic myomectomy 351Jurnalul de Chirurgie (Iaşi), 2012, Vol. 8, Nr. 4of 57cm 3 . Barakat et al, in his comparativeanalysis, similar to ours, indicates uterinevolume similar in the two groups, of 223cm 3 for robotic myomectomy and 263 cm 3for open myomectomy [5]. Roopina Sanghaet al, in another study performed in2010, indicated a dimension of extractedmyomas in robotic interventions greater than7.6 cm [7].Thus, we can observe that computerassisted myomectomy is more suitable incase of a larger number of myomas, but witha smaller size, while laparotomymyomectomy is more suitable for myomaswith larger size.The difference in blood loss betweenthe two types of interventions was greaterthan 100 mL, with a difference inpostoperative hemoglobin of about one unit.We have found in other studies valuessimilar to ours. In his analysis, Bedient et al,in 2009 [8], reported a blood loss ofapproximately 100 mL, and Barakat et al, in2011 [5], in a comparative study, reportedthe following results: 200 mL forlaparotomy myomectomy and 150 mL forrobotic myomectomy. Also, a comparativeanalysis was performed by Ranisavljevic etal, in 2012 reported a blood loss of 397 mLin laparotomy interventions and 387 mL inrobotic assisted interventions [9].The length of hospital stay was 3 timesgreater for open myomectomy, andimplicitly the in-hospital costs. In his study,Ranisavljevic et al, in 2012, indicated aduration of hospitalization of 7.2 days foropen myomectomy, and 3.9 days for patientswho received robotic assisted treatment [9].At the same time, Barakat et al. reported anin-hospital stay of one day for roboticassisted myomectomy and 3 days forlaparotomy myomectomy [5].From the point of view ofintraoperative and postoperativecomplications, we noticed morecomplications in the group of patients whosuffered laparotomy interventions.From these results we concluded thatrobotic assisted laparoscopic treatmentcomes with superior results compared toopen myomectomy, with less blood loss anda shorter length of hospital stay.Morbidity of patients who receivedrobotic assisted laparoscopic was lowercompared to open-surgery patients, due tomuch lower postoperative pain, minimizedincidence of postoperative anemia and rapidreintegration into society.Even if the cost of robotic assistedsurgery is higher compared to open, superiorresults and conditions for surgery should besufficient to determine more medical centersto buy such equipment and train their ownteams in this technique.However, we are still pioneering inthis technique and it is necessary to publishmany more similar comparative studies, inorder to demonstrate and highlight thesuperiority of robotic surgery overlaparotomy.ACKNOWLEDGEMENTSThe first author was supported by thePOSDRU/88/1.5/S/52826 grant entitledDevelopment of PhD Schools by offeringscholarships to full-time PhD students.During PhD she was enrolled for fourmonths in the Santa Chiara Hospital underdirect supervision of Professor AndreaGenazzani.CONFLICT OF INTERESTSNone to declare.REFERENCES1. Holloway RW, Patel SD, Ahmad S. Roboticsurgery in gynecology. Scandinavian Journalof Surgery. 2009; 98: 96-109.2. Senapati S, Advincula AP. Surgical tehniques:robot-assisted laparoscopic myomectomy withthe da Vinci Surgical System. J Robotic Surg.2007; 1: 69-74.3. Lobontiu A, Loisance D. Chirurgia robotică:viitor la present. 2006. www.emedic.ro;available online at: http://www.emedic.ro/Articole/15.htm4. Soler L, Forest C, Nicolau S et al. Computerassistedoperative procedure:from preoperativeplanning to simulation. Eur Clinics ObstetGynaecol. 2007; 2: 201-208.5. Barakat EE, Bedaiwy MA, Zimberg S, NutterB, Nosseir M, Falcone T. Robotic-assisted,laparoscopic, and abdominal myomectomy: a
352 Săceanu SM. et al.Jurnalul de Chirurgie (Iaşi), 2012, Vol. 8, Nr. 4comparison of surgical outcomes. ObstetGynecol. 2011; 117(2 Pt 1): 256-265.6. Gargiulo AR, Srouji SS, Missmer SA, CorreiaKF, Vellinga T, Einarsson JI. Robot-assistedlaparoscopic myomectomy compared withstandard laparoscopic myomectomy. ObstetGynecol. 2012; 120(2 Pt 1): 284-291.7. Sangha R, Eisenstein DI, George A, MunkarahA, Wegienka G. Surgical outcomes forrobotic-assisted laparoscopic myomectomycompared to abdominal myomectomy. JRobotic Surg. 2010; 4(4): 229–233.8. Bedient CE, Magrina JF, Noble BN, Kho RM.Comparison of robotic and laparoscopicmyomectomy. Am J Obstet Gynecol. 2009.201(6): 566.e1-5.9. Ranisavljevic N, Mercier G, Masia F, Mares P,De Tayrac R, Triopon G. Robot-assistedlaparoscopic myomectomy: Comparison withabdominal myomectomy. J Gynecol ObstetBiol Reprod (Paris). 2012; 41(5): 439-444.
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