Total Robotic Myomectomy in a Complex Case: Extending the Limits

Abstract

We present the case of a 30-year-old female with primary infertility who had multiple large myomas up to 22 weeks uterine size. She had a body mass index of 42 kg/m² and also concurrent endometriosis, for which she was on medical management. After meticulous preoperative planning, total robotic myomectomy and endometriosis clearance was done. Four large myomas weighing a total of 750 g were removed after morcellation. Console time was 160 min, and she made an uneventful recovery with only 0.1 g/dL drop in hemoglobin. Robotic myomectomy is considered as an improvement over laparotomy for patients with up to three myomas and when the surgical time does not exceed 4 hours. We were successful in our attempt at total robotic myomectomy to extend these limits and had a positive surgical outcome.

Keywords: Large myomas; morbid obesity; multiple myomas; total robotic myomectomy.

Figure 1

Magnetic resonance imaging images (a and b)

Figure 2

Representative Port Placement for pelvic docking

Figure 3

(a) Preoperative and (b) postoperative uterine contour

Figure 4

Morcellated myoma fragments