Miguel Caceres
Pacifica Salud Hospital, PanamaPresentation Title:
Removal of myomas by posterior colpotomy in laparoscopic myomectomy assisted by robot (HUGO RAS)
Abstract
Objective: To describe the extraction of fibroids by posterior colpotomy with the HUGO RAS robotic system.
Design: Demonstration of our 7-step technique with narrated video footage.
Setting: After laparoscopic resection of a fibroid, there are various extraction techniques, including morcellation and posterior colpotomy. The latter, which is not described in HUGO RAS robotic surgery, stands out for being a safe and minimally invasive approach. The advantages of robotic myomectomy are: less pain, faster recovery, less bleeding, greater precision and better visualization. (1-3)
In response to growing concerns about the potential for disseminating occult malignancies during electrical morcellation of fibroids, the FDA issued safety warnings in 2014. (4) Fibroid removal by laparoscopic posterior colpotomy (LCPS) combines laparoscopy with a vaginal incision for fibroid removal, thus avoiding morcellation. (5)
Interventions: This is the world's first description of posterior colpotomy applied in HUGO robotic surgery. We summarize in 7 steps:
1. Abdominal incisions to introduce trocars and a laparoscope. Robotic arms and instruments are attached.
2. Visualization of the uterus in 3D through the laparoscope, and incision planning.
3. Placing a vasopressor in the fibroids to reduce bleeding during surgery.
4. Removal of fibroids using robotic instruments.
5. CCL vaginal extractor is placed at the bottom of the vagina.
6. An incision is made in the vagina, laparoscopically, and the fibroids are extracted vaginally in a sterile, self-opening bag.
7. The vaginal incision is closed with barbed or braided multifilamentous sutures.
Conclusion: the extraction of fibroids by colpotomy in robotic surgery is a viable alternative, easy to perform and totally replicable, maintaining the benefits of robotic surgery, with better aesthetic results and lower risk of dissemination of malignant tumors hidden.
Biography
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