Study On Robot-assisted Laparoscopic Myomectoy

Background Uterine myoma is the most common benign tumor of women of childbearing age, composed of smooth muscle and connective tissue, Clinical symptoms are often manifest as abnormal uterine bleeding, chronic pelvic pain, painful intercourse and oppression of the bladder or the rectum, and these lead to frequent urination,constipation and other symptoms. For those who have symptoms or suspected patients with sarcomas, surgery is the main treatment. Myomectomy can retain the female fertility function and integrity of organs, trans-abdominal myomectomy(TAM) has the disadvantages of the lager damage and more postoperative complications. In recent years, with the development of minimally invasive technology, laparoscopic myomectomy(LM) and trans-vaginal myomectomy(TVM) are safe and effective operation methods for symptomatic patients, each of them has beautiful incision, faster postoperative recovery, less postoperative complications and other advantages,so they have been widely used in clinical, but for multiple uterine fibroids or special parts of the myoma, the application of laparoscopy is still a certain degree of restriction, due to the surgical space is narrow, TVM is always with high postoperative morbidity, which is not suitable for all patients who conform to the operation indication. With the invention of the Da Vinci robotic surgery system, the gynecologic minimally invasive technology is injected a new energy.Objective In this article, through analysis of robot-assisted laparoscopic myomectomy(RALM), TAM, TVM and LM applied to the clinical data of patients with uterine fibroids, explore the safety and feasibility of RALM.Methods A retrospective analysis was carried out on 117 patients with uterus myoma eliminating from July 2013 to December 2014 in shenyang military region general hospital, the patients were grouped according to the different surgical method, the case number of the robot group was 17, the laparoscope group was 40, the TVH group was30, the abdominal group was 30. Collected of the four groups of patients information in age, body mass index, fibroids features(the type, position, number and size), operation time, intraoperative blood loss, postoperative morbidity, postoperative exhaust time,postoperative hospitalization time and expenses, establish database tables for statistical analysis.Results 1. Four groups’ patients in age, body mass index, fibroids type, compared with no statistical difference(p>0.05); 2. Robot group compared with abdominal group,there were no significant differences in myoma location, number and size, there were significant differences in operation time, intraoperative blood loss, postoperative exhaust time, postoperative morbidity, postoperative hospitalization time and expenses(p<0.05), although operation time of the robot group was longer, the higher cost of hospitalization, but was less bleeding than abdominal group obviously, shorter postoperative exhaust time, fewer postoperative complications, shorter hospitalization time; 3.The RALM group, the LM group and TVH group, no cases of them were converted to laparotomy, there were no statistical differences in postoperative exhaust time, postoperative morbidity and postoperative hospitalization time(p>0.05), but there were significant differences in operation time, intraoperative blood loss, fibroids number and size and hospitalization expenses(p<0.05), robot group was less intraoperative blood loss(48.24 ± 28.336 ml), the eliminate myoma number was more(number was 2.47 ± 3.023 cm), the eliminate fibroid volume is the largest(diameter was6.41 ± 1.670 cm), compared with the other two groups were statistically significant(p<0.05).Conclusion 1. RALM group and TAM group had the same clinical outcomes, but because RALM group had smaller abdominal incision, less intraoperative blood loss and fewer perioperative complications, it was a safe, minimally invasive operation method;2. RALM group compared with LM group and TVH group, RALM group had the higher cost, but less intraoperative blood loss, larger number of myoma and volume,shorter postoperative exhaust time, it was more suitable for complex parts of myomectomy, so for the patients who had symptoms, good economic conditions and required to retain the fertility function and the uterine, robot can yet be regarded as the best choice; 3. Due to fewer sample size of the robot group in this study, the long-term postoperative complications and prognosis of robot will be still need to accumulate a large sample of data and further research.