Héctor Salvador Godoy Morales1, Radamés Rivas López2, Germán Gabriel Palacios López3, Pablo Joaquín Cervantes Mondragón4, Daniel Vieyra Cortés5, Hilda Sánchez Hernández6, Miguel Loyo Guiot6, Francisco Miguel Rojas Camacho6. 1. Head of the Fertility Clinic at Ángeles del Pedregal Hospital, Lead Professor of the Human Reproductive Medicine Course, Robotic Gynecological Surgeon, Mexico City, Mexico. 2. Associate Professor of the Human Reproductive Medicine Course, Gynecological Robotic Surgeon, Ángeles del Pedregal Hospital, Mexico City, Mexico. 3. Specialist in Human Reproductive Medicine and Master in Health Sciences, Mexico City, Mexico. 4. Specialist in Human Reproductive Medicine, Mexico City, Mexico. 5. Associate Professor of the Human Reproductive Medicine Course, Ángeles del Pedregal Hospital, Mexico City, Mexico. 6. Resident of Human Reproductive Medicine at Ángeles del Pedregal Hospital, Mexico City, Mexico.
Abstract
OBJECTIVE: To compare approaches to myomectomy (laparotomic, laparoscopic, and robotic). To show the relationship between the number of fibroids and the reproduction diagnosis. METHODS: Observational, analytical, retrospective, and cross-sectional study; where the surgical approach used, was evaluated in terms of surgical bleeding, time, number and weight of fibroids and reproductive results. RESULTS: 69 patients were treated through different approaches and divided into 3 groups. The differences found among groups were in favor of laparotomic myomectomy in terms of the number (p=0.000) and weight of fibroids (p=0.004). Robotic surgery was also longer (p=0.000). In the analysis of the influence of the number of fibroids to achieve pregnancy, the result was in favor of the minimally invasive routes, after surgery, both in the group of < 6 fibroids (p=0.017), and that of > 6 fibroids (p=0.001), without differences in the time from surgery to pregnancy (p=0.979). CONCLUSIONS: The surgical approach decision should consider the number and size of resected fibroids, surgical time, and reproductive diagnosis. The minimally invasive route should be offered whenever possible due to its better outcome on achieving pregnancy, without forgetting the benefits of laparotomy, while also accrediting the recently introduced robotic-assisted approach.
OBJECTIVE: To compare approaches to myomectomy (laparotomic, laparoscopic, and robotic). To show the relationship between the number of fibroids and the reproduction diagnosis. METHODS: Observational, analytical, retrospective, and cross-sectional study; where the surgical approach used, was evaluated in terms of surgical bleeding, time, number and weight of fibroids and reproductive results. RESULTS: 69 patients were treated through different approaches and divided into 3 groups. The differences found among groups were in favor of laparotomic myomectomy in terms of the number (p=0.000) and weight of fibroids (p=0.004). Robotic surgery was also longer (p=0.000). In the analysis of the influence of the number of fibroids to achieve pregnancy, the result was in favor of the minimally invasive routes, after surgery, both in the group of < 6 fibroids (p=0.017), and that of > 6 fibroids (p=0.001), without differences in the time from surgery to pregnancy (p=0.979). CONCLUSIONS: The surgical approach decision should consider the number and size of resected fibroids, surgical time, and reproductive diagnosis. The minimally invasive route should be offered whenever possible due to its better outcome on achieving pregnancy, without forgetting the benefits of laparotomy, while also accrediting the recently introduced robotic-assisted approach.
Entities:
Keywords:
fibroids; infertility; laparoscopic surgery; myomectomy; robotic surgery
Authors: Millie A Behera; Creighton E Likes; John P Judd; Jason C Barnett; Laura J Havrilesky; Jennifer M Wu Journal: J Minim Invasive Gynecol Date: 2011-11-18 Impact factor: 4.137