Clinical experience of robotic myomectomy for fertility preservation using preoperative magnetic resonance imaging predictor

Abstract

Objective: This study aimed to demonstrate the use of preoperative magnetic resonance imaging (MRI) findings to select the optimal surgical technique between single-site (SS) and multi-site (MS) robotic myomectomy based on clinical experience, for the preservation of fertility.

Methods: Ninety-eight patients who underwent SS or MS robotic myomectomy using the da Vinci® Si system after undergoing MRI were evaluated retrospectively. The correlation between preoperative MRI findings and the intraoperative or postoperative findings during robotic myomectomy for the preservation of fertility was analyzed. The reproductive outcome was investigated when the patient wished to conceive.

Results: The mean age of the patients was 35.68±5.04 years and 80 patients (81.6%) were nulliparous. The total diameter of myomas on MRI was 106.75±54.52 mm. The number of resected myomas was 4.31±4.39 (range, 1-27), and the total weight of resected myomas was 293.11±281.13 (range, 30-1,260) g. Myomas with high signal intensity on MRI required less time for resection. MS robotic myomectomy was performed for an increased number and total diameter of a myoma or a deep-seated myoma. Postoperatively, all patients resumed normal menstruation. Of the 15 patients who wished to conceive, 12 (80%) conceived successfully. Of these, uterine dehiscence occurred in 1 patient and 10 patients underwent an uneventful cesarean section.

Conclusion: SS or MS robotic myomectomy can be recommended for patients who wish to conserve fertility. However, the optimal surgical technique should be selected based on preoperative MRI findings to predict an effective surgical process and the successful preservation of fertility.

Keywords: Fertility preservation; Magnetic resonance imaging; Uterine myomectomy.

Fig. 1.

The relationship between T2 signal intensity (SI) and chopping time.

Fig. 2.

The relationship between enhancement and estimated blood loss (EBL).

Fig. 3.

Magnetic resonance imaging (MRI) and operative findings. (A) Sagittal T2-weighted MR images (T2WI) shows well-defined leiomyoma (arrows) with low signal intensity in posterior corpus of the uterus. This case was assigned as grade 3 in terms of SI of T2WI. (B) Huge myoma was extracted from the uterus and the uterine myometrium and serosa were sutured layer by layer for more than 3 layers using the da Vinci^® Si Surgical System.