It is advantageous to perform surgery in the
least invasive way possible while still getting optimal results. Although I
usually prefer to do surgery through a laparoscope rather than through a
larger incision, I have felt limited by the lack of wrist-like movements of
the instruments. I felt that deeper myomas (that couldn’t be removed by a
hysteroscope) were better removed through a regular incision.
The da Vinci
surgical robot is a major advance in the ability to precisely operate
through small incisions. As shown below, the surgeon sits at a console (see
photo) and looks through a 3-dimensional videocamera.
The hand movements in the
surgeon are duplicated in the patient by the robot. Most importantly, the
instruments duplicate the wrist movements of the surgeon, allowing the
instruments to change angles to allow precise suturing. (Photo below shows
robot being used in delicate heart surgery.)
Here are photos of an actual
robotic myomectomy in which I removed 5 fibroids:
1. An
incision is being made with the da Vinci robot through the myometrium
(muscle of the uterus) down to the fibroid.
2. The
fibroid is grasped and dissected away from the surrounding myometrium.
3. The
fibroid is almost free. Another small fibroid, which will also be removed,
is seen at the bottom right.
4. The area
where the myoma was is being sutured in layers.
The da Vinci
does not always eliminate the need for abdominal myomectomy. When there are very
large myomas and/or many myomas an
abdominal myomectomy may be preferable.
I frequently get email
asking how big is big and how many are too many. All of this is
relative. The size of the uterus, the size of the woman, and the
desire to retain fertility are only a few of the factors that enter into the
decision making process. I can not make meaningful recommendations
without actually seeing you! I frequently find that the records
are quite different than what I find on my own evaluation, and that my
recommendations after seeing someone are totally different than I would have
made from reviewing records alone.
©2006, Paul Indman, MD. All Rights
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15195 National Avenue, Suite 201; Los Gatos, CA 95032
Telephone : 408 358-2788 ; FAX : 408 356-5526
The
medical information presented in this website represents the opinion of Dr.
Indman, and is based on his knowledge and experience. It is not
applicable to all patients or physicians. Anyone visiting this or other
related medical sites should discuss symptoms, findings, and alternatives with
their personal gynecologist.
