For nearly 175 years, BWH has provided women with innovative health care, advancing medical technology and techniques such as robotic myomectomy procedures and in vitro fertilization treatment. Ranked consistently by U.S. News & World Report as one of the leading gynecology providers in the country, BWH is a world leader in robotic reproductive surgery. The Center for Infertility and Reproductive Surgery at BWH has pioneered state-of-the-art robotics to improve surgery outcomes and preserve fertility
Therefore, patients interested in robotic myomectomy will find one of the world's leading providers of robotic surgery at Brigham and Women's Hospital (BWH) in Boston. A myomectomy is a conservative gynecological surgery to remove one or more fibroid tumors from the uterus. Even though uterine fibroids are most often benign (non-cancerous) tumors, they can cause significant medical problems, such as abnormal uterine bleeding, abdominal pain and urinary incontinence as well as infertility, pregnancy loss and other reproductive complications.
The decision of whether uterine fibroids should be removed to improve a woman's ability to have a baby is always a very delicate one, which should involve high-specialty counseling by an infertility or a maternal-fetal medicine expert. In other cases (abnormal bleeding, pain and incontinence) the decision is more straightforward and myomectomy becomes an excellent alternative to more complex and involved surgical options such as a hysterectomy.
Traditionally, myomectomy has been performed through an abdominal incision similar to the one employed for cesarean births. This operation, known as open myomectomy, involves hospitalization, a lengthy and uncomfortable recovery and a significant risk of operative and long-term complications. In spite of overwhelming scientific evidence pointing to the inferior clinical results of open myomectomy compared to laparoscopic myomectomy, the majority of myomectomies in this country are still being performed through this traditional route. This is because laparoscopic myomectomy is one of the most technically challenging gynecologic operations and requires years of extensive sub-specialty surgical training to master.
Gynecologists at Brigham and Women's Hospital (BWH) have taken an early and definitive stand against the widespread use of open surgery, thanks to their pioneering adoption of laparoscopic and robotic technology. Surgeons at the Center for Infertility and Reproductive Surgery have routinely offered conventional laparoscopic myomectomy since 1996 and a robotic myomectomy since 2007. A Robotic myomectomy is performed an outpatient basis, by the Center for Infertility and Reproductive Surgery and by the Division for Minimally Invasive Gynecologic Surgery.
BWH surgeons use the latest models of single and dual consoles da vinci® Si Surgical Systems to carry out complex robotic myomectomy procedures. Sitting at a console a short distance from the patient, the physician's controls up to four robotic arms with miniature tools that can execute a wide variety of surgical tasks. The surgeons observes the myomectomy surgical area through a fully immersive, panoramic, high-definition 3-D visor that offers magnification, depth of field and a sweeping view of the pelvic anatomy. As the surgeons guide the arms, the robotic technology provides for smooth and steady movements, allowing the best level of precision to perform this delicate reconstructive surgery. With enhanced visualization and greater range and fluidity of movement, the technology enables surgeons to safely perform minimally invasive myomectomy under the most challenging of circumstances (extreme obesity, pelvic adhesions, severe endometriosis, unusual fibroid locations). The procedure requires only tiny incisions that results in less blood loss and post-surgical pain, faster recovery, less scarring, and a decreased likelihood of complications compared to open myomectomy.
Dr. Antonio R. Gargiulo, Medical Director of Robotic Surgery at BWH and his surgical team have performed over 600 consecutive robotic operations (mostly myomectomies) since 2007 without ever needing to convert to an open surgery. In addition to robotic myomectomy, BWH surgeons perform robotic excision of severe endometriosis, robotic adenomyomectomy, robotic reversal of tubal sterilization and other robot-assisted benign gynecologic surgeries including robotic hysterectomy. Dr. Gargiulo's team has developed and performed the hybrid conventional-robotic myomectomy technique for removal of very large fibroids, as well as a novel highly cosmetic approach to advanced robotic surgery that leaves no visible scars above the pubic-groin area. Lastly, Dr. Gargiulo's reproductive robotic surgery team has recently described the first series of single incision robotic myomectomies in the world: allowing the performance of a complete myomectomy operation through a single umbilical incision.
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