Ali Akdemir¹
Sabahattin Anıl Arı²

¹Ege University, Faculty of Medicine, Department of Gynecology and Obstetric, İzmir, Türkiye
²İzmir Bakırçay University, Faculty of Medicine, Department of Gynecology and Obstetric, İzmir, Türkiye

Akdemir A, Arı SA. Myomectomy with Robotic Surgery. Yavuz AF, ed. Myoma Uteri. 1^st ed. Ankara: Türkiye Klinikleri; 2025. p.103-110.

ABSTRACT

The development of surgical robotics was driven by the desire to overcome the limitations of tradi- tional laparoscopy, such as two-dimensional imaging, rigid instruments, and ergonomic challenges. Robotic-assisted laparoscopic surgery improves patient outcomes by converting procedures that would normally require a laparotomy into minimally invasive interventions. The choice between a minimally invasive myomectomy and a laparotomy largely depends on the surgeon’s expertise and the location, size, and number of leiomyomas. Robotic instruments, offering seven degrees of freedom, enable ‘En- doWrist’ movements that closely replicate the dexterity of the human hand, greatly facilitating tasks like suturing, particularly for less experienced surgeons. Despite its benefits, robotic technology has some drawbacks, including the need for specialized training, higher costs, longer operating times, bulky equipment, elevated instrument expenses, limited tool flexibility, lack of tactile feedback, and potential for mechanical failures. Bleeding, although common in all myomectomy procedures, tends to be less severe in robotic myomectomy. Maintaining a hemoglobin level above 12 g/dL is critical to minimize complications, as the risk increases with lower levels. The use of the third robotic arm to manipulate the myoma provides a significant advantage over conventional laparoscopy in myomec- tomy procedures. When power morcellation is necessary, it should be performed within a completely enclosed endo bag to prevent tissue dissemination. Gynecologic surgeons should strive to limit the use of power morcellation whenever possible, as newer techniques have been developed to minimize the risk of unintended tissue spread.

Keywords: Fertility preservation; Minimally invasive surgery; Morcellation; Robotic myomectomy; Tissue removal