Arnold Advincula's Surgical Techniques

Robot-assisted laparoscopic myomectomy

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With contained extracorporeal C-incision tissue extraction of a myoma in a 39-year-old woman with heavy menstrual bleeding



The management of symptomatic uterine fibroids in the patient desiring conservative surgical therapy can be challenging at times. The advent of robot-assisted laparoscopy has provided surgeons with an enabling tool and patients with the option for a minimally invasive approach to myomectomy.

This month’s video was produced in order to demonstrate a systematic approach to the robot-assisted laparoscopic myomectomy in patients who are candidates. The example case is removal of a 5-cm, intrauterine posterior myoma in a 39-year-old woman (G3P1021) with heavy menstrual bleeding who desires future fertility.

Key objectives of the video include:

  1. understanding the role of radiologic imaging as part of preoperative surgical planning
  2. recognizing the key robotic instruments and suture selected to perform the procedure
  3. discussing robot-specific techniques that facilitate fibroid enucleation and hysterotomy repair.

Also integrated into this video is the application of the ExCITE technique—a manual cold knife tissue extraction technique utilizing an extracorporeal semi-circle “C-incision” approach—for tissue extraction. This technique was featured in an earlier installment of the video channel.1

I hope that you find this month’s video helpful to your surgical practice.

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Next Article:

2016 Update on minimally invasive gynecologic surgery

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