Robot-assisted laparoscopic myomectomy and adenomyomectomy with a flexible CO2 laser device.

We describe a novel surgical technique combining the use of a robotic surgical platform with a flexible CO2 laser in gynecologic surgery at a university-hospital-based reproductive medicine practice. Thirteen women with symptomatic uterine fibroids and/or adenomyosis, desiring uterine conservation, underwent robot-assisted laparoscopic myomectomy or focal adenomyomectomy with CO2 laser energy using a novel flexible delivery fiber (BeamPath GYN-L fiber, OmniGuide, Cambridge, MA, USA). On average, four myomas or areas of adenomyosis were removed with an average total specimen weight of 95 g. The average operating time was 169 min and the average estimated blood loss was 25 mL. No perioperative complications were observed. Preliminary experience with robot-assisted minimally invasive gynecologic surgery utilizing a novel flexible CO2 laser fiber has comparable operative outcomes to those reported for conventional laparoscopic energy sources, and this technique appears safe. The minimal lateral thermal spread of photonic energy, combined with the enhanced precision allowed by a computer-based surgical platform, appears ideal for reproductive surgical applications.