Tesi di specializzazione
Robot-assisted laparoscopic myomectomy: feasibility, fertility outcome and short term results in comparison to laparoscopy
MEDICINA E CHIRURGIA
Corso di studi
GINECOLOGIA E OSTETRICIA
relatore Prof. Gadducci, Angiolo
Data inizio appello
Laparoscopic myomectomy has recently gained wide acceptance but this procedure remains technically highly demanding and concerns have been raised about the increased blood loss and an higher risk of postoperative uterine rupture of the pregnant uterus. The use of robotic technology, providing instruments with a wrist function at the tip, movement downgrading, tremor elimination, a stable 3-Dimension view and a comfortable working position enhances surgical dexterity and improves fibroids enucleation and suture capability when compared with laparoscopy. The aim of the present study is to evaluate the feasibility, fertility outcome and short term results of robot-assisted laparoscopic myomectomy (RALM). In addiction, our initial experience with robotic myomectomy has been compared with our initial experience with laparoscopic mymectomy. Data from 48 RALM performed in our department between the years 2007-2011 have been collected. Conception rate, abortion rate, incidence of feto-maternal morbidity or severe pregnancy and labour-related complications were reported; FSH and AMH levels and ultrasound valutation of AFC has been made before and 6 months after operation. Number of cesarean sections and vaginal deliveries were described. The average age of the patients was 35 years and median Body Mass Index was 23 kg/m2 (range 18-35 kg/m2). 7 women (13%) became pregnant after RALM with 8 pregnancies. One pregnancy is actually on going; there were 6 deliveries with caesarian section and one spontaneous delivery. No spontaneous abortions. No uterine ruptures occurred. No significant modification of ovarian function was found after myomectomy. As far as comparison with laparoscopic myomectomy, robotic seems to give advanteges over laparoscopy in term of bleeding, suturing and uterine wall reconstruction. In conclusion RALM seems to be feasible with good short-term results and to have a favorable impact on the reproductive outcome of young patients with no impact on the ovarian function.