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However, the demand for using the lowest number of ports to induce compatible surgical outcomes has always been sought out in gynecologic surgery due to poorer cosmesis, higher costs, and the complexity of robotic multi-port (RMP) surgery compared to traditional single-port incision laparoscopic surgery. Robot-guided myomectomy has been accepted as a reproducible, safe, and successful means of resecting myomas without compromising the quality of the operative procedure, with delicate tools available for adequate myometrial sutures. With the introduction of robot-guided surgery, which provides stereoscopic binocular vision, absorption of physiologic hand tremors, and wristed motion of surgical tools, minimally invasive gynecologic surgery has become more sophisticated. When the lowest number of ports is desired, single-incision laparoscopy-guided myomectomy could also be performed however, the added limitations of the degree of freedom for surgical tool manipulation have hindered its widespread application. However, the limitations of ergonomics, longer learning curves, and uterine dehiscence after pregnancy due to suboptimal suture conditions are the main concerns regarding laparoscopic myomectomy, especially for deep intramural myomas. Myomectomy using minimally invasive surgery (MIS) techniques has important advantages with regard to postoperative morbidity and the speed of recovery, with less intraoperative blood loss and shorter hospital stays. When conservative, symptomatic treatment for myomas fails in those wishing to preserve fertility, a laparotomy, laparoscopy, or robot-guided myomectomy is the preferred choice.
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Uterine myomas are diagnosed in approximately 25–40% of women during the reproductive age, causing menorrhagia, dysmenorrhea, anemia, pressure symptoms due to mass effect, and possible pregnancy-related complications. The advantage of shorter total operative time and less pain with the same amount of analgesic drugs in RSS myomectomy will contribute to improving patient satisfaction. Conclusionsĭa Vinci RSS myomectomy is a compatible option with regard to reproducibility and safety, without significantly compromising the number and sum of the maximal diameter of myomas removed. No other noticeable complications were observed in either group. The rate of transfusion, estimated blood loss during the operation, and length of hospital stay were not different between the two modalities. RMP: 2.7 ± 0.8 days, p = 0.0149), with similar consumption of analgesic drugs. The visual analog scale pain score 1 day postoperatively was significantly lower in the RSS group (RSS: 2.4 ± 0.8 days vs. The RSS group tended to have a longer docking time (RSS: 9.8 ± 6.5 min vs. After propensity score matching, the total operative time (RSS: 150.9 ± 57.1 min vs.
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The RSS group was younger, had lesser number of myomas removed, and had a smaller sum of the maximal diameter of total myomas removed than the RMP group. The body mass index, parity, preoperative hemoglobin levels, mean maximal myoma diameter, and anatomical type of myoma showed no mean differences between RSS and RMP myomectomies. Patient demographics, preoperative parameters, intraoperative characteristics, and postoperative outcome measures were analyzed. After 1:1 propensity score matching for the total myoma number, total myoma diameter, and patient age, 90 patients in each group (RSS: n = 90 RMP: n = 90) were evaluated. This retrospective case–control study was performed on 236 robotic myomectomies at a university medical center. This study aimed to evaluate the compatibility of robotic single-site (RSS) myomectomy in comparison with the conventional robotic multi-port (RMP) myomectomy to achieve successful surgical outcomes with reliability and reproducibility.