Robotic Myomectomy Overview

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Brigham and Women’s Hospital’s (BWH) Center for Infertility and Reproductive Surgery is a world leader in using state-of-the-art robotics to improve reproductive surgery outcomes. This advanced technology’s potential to expand the scope of minimally invasive (laparoscopic) surgery and shorten patient recovery time is motivating more and more of our patients to consider robotic surgery as a safe and effective means of preserving and improving their fertility while eliminating adverse symptoms.

What is a myomectomy?

A myomectomy is the surgical removal of uterine fibroids (tumors) while leaving the uterus intact, thereby preserving the possibility of future pregnancy. Uterine fibroids are typically non-cancerous, but can cause significant symptoms, such as bleeding, pain and incontinence.

Uterine Fibroids

What is a robotic myomectomy?

Robotic myomectomy uses a combination of high-definition 3D magnification, robotic technology and miniature instruments to enhance a reproductive surgeon’s skills when removing uterine fibroids and reconstructing the uterine wall.

Since performing Boston’s first robot-assisted hybrid myomectomy for the removal of very large fibroids, Antonio R. Gargiulo, MD, Director of Robotic Surgery, Division of Reproductive Medicine, and Serene Srouji, MD, Associate Director of Robotic Surgery, Reproductive Medicine, have used the FDA-approved da Vinci® Surgical System to collectively perform several hundred robotic myomectomies. The system consists of a surgeon’s console, equipped with a control panel and a hi-definition monitor, and a patient side-cart, outfitted with slender robotic arms and attended by another surgeon and a nurse.

Traditional open myomectomy requires one large incision and retraction to accommodate human hands, but only tiny incisions in the abdomen are required for the slender robotic arms and tiny surgical tools used in a robotic myomectomy. There are four available arms, which are all wristed – one equipped with a high definition 3-D magnification camera, two that act as the surgeon’s arms and an optional arm that can be used for holding back tissue. The camera gives the surgeon enhanced detail, true depth of field and a panoramic view, and the robotic hands’ broad range of movement enables greater dexterity. This enhanced visualization, precision and dexterity provide significant advantages when delicately removing uterine fibroids and thoroughly reconstructing the uterine wall, thereby helping to preserve fertility.

These capabilities are further enhanced by the surgical console’s unique ergonomics that help ease surgeon fatigue and mechanics that enable steady movements. The surgeon remotely guides the robotic arms while seated at the console, located a short distance away from the patient. These smooth and effortless movements, along with the wristed capabilities of the robotic arms, are the most significant advantages that robotic surgery has over traditional minimally invasive surgical procedures.

What are the benefits of a robotic myomectomy?

Robotic surgery’s miniaturization, increased range of motion, enhanced vision and mechanical precision offer significant benefits for our myomectomy patients, including:

  • Less blood loss
  • Less post-surgical pain/less medication
  • Quicker recovery and return to normal activities
  • Less scarring
  • Less likelihood of complications
  • Preservation of fertility

Who performs robot-assisted myomectomies at BWH?

Antonio R. Gargiulo, MD, and Serene Srouji, MD, launched BWH’s Robot-Assisted Reproductive Surgery program when they performed New England’s first successful robot-assisted laparoscopic tubal sterilization reversal in January 2007. They have since continued this accomplished partnership to perform more than 400 robot-assisted surgeries at BWH. In addition to reversal of tubal ligation and myomectomy, Drs Gargiulo and Srouji can also use the robot to perform other types of complex laparoscopies, such as procedures to remove pelvic endometriosis. Gargiulo and Srouji are also leading advocates of the technology, regularly teaching robotic procedures to observers from throughout the world.

How can I learn more about robotic myomectomy?

If you would like to schedule a consultation with Dr. Gargiulo or Dr. Srouji, please call the Patient Referral Service, staffed 8am-5:30pm, Monday through Friday, at 1-800-294-9999, or fill out an online request form.

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