P-738 Reproductive surgery for fertility preservation: Robotic single-port myomectomy (da Vinci® SP) versus robotic single-site myomectomy (da Vinci® Xi or Si)
Authors: Jeong K , Lee J  H , Park S  Y , Shin W , Chung H  W 
Published: July 2024

Abstract

Study question
To compare clinical and surgical outcomes of robotic single-port myomectomy using da Vinci® SP and robotic single-site myomectomy with Xi or Si for fertility preservation.

Summary answer
The robotic single-port myomectomy (da Vinci® SP) might be feasible, even if the myoma is deep-seated, compared to robotic single-site myomectomy (Xi or Si system).

What is known already
Myomas are clinically apparent in about 25% of women and become symptomatic in their reproductive age. Myomectomy is the choice of treatment for women desiring uterine preservation, especially in deep-seated fibroid that can affect pregnancy. Although young women prefer minimal invasive surgical technique with less scar, single-port laparoscopic myomectomy has some limitations. Adoption of the da Vinci® system made it possible to overcome the weaknesses of laparoscopy. Owing to the ability of single-port laparoscopy to reduce pain and improve patient satisfaction, robotic single-site surgery was developed in order of the da Vinci® Si, Xi and the latest new SP system.

Study design, size, duration
We retrospectively reviewed medical records of 214 patients who underwent robotic single-port myomectomy (RSPM, n = 111) using the da Vinci® SP surgical system or robotic single-site myomectomy (RSSM, n = 103) with the da Vinci® Xi or Si system between October 2015 and September 2023 at Ewha Womans University Mokdong Hospital. Baseline characteristics and operative outcomes were compared and analyzed between the RSPM and RSSM groups.

Participants/materials, setting, methods
We assessed FIGO classification and maximum diameter of fibroid. The incision time, docking time, console time, wound closure time, total operation time, estimated blood loss (EBL), chopping time for specimen removal, the number and weight of removed myoma were measured.

Main results and the role of chance
Mean age (38.5±6.6 vs 37.3±6.6 years) and anthropometric index were not significantly different between RSPM and RSSM groups. Although the diameter (7.1±1.4 vs 7.2±2.0 cm), number (3.1±2.7 vs 2.5±2.2), and weight (149.1±107.1 vs 146.4±130.6 g) of myoma were not significantly different between the two groups, the more deep-seated myoma diagnosed by FIGO classification (2.9±1.5 vs 4.6±2.0, p&lt;0.0001) could be resected in RSPM group. The incision (3.6±1.9 vs 7.3±4.4 min, p &lt;0.0001) and docking time (2.7±1.4 vs 4.6±1.6 min. p&lt;0.0001) were less in the group of RSPM compared to RSSM that was earlier implementation. Depending on the differences in da Vinci® SP and Xi or Si systems, the wound was slightly larger, requiring shorter chopping time (6.4±5.0 vs 8.4±7.2 min, p=0.022) and longer closure time (12.8±4.4 vs 10.9±3.6 min, p=0.001) in the RSPM group. Additionally, more complex surgeries with larger blood loss (264.1±140.2 vs 176.8±132.0 ml, p&lt;0.0001), longer console time (60.5±33.2 vs 49.7±22.6 min, p=0.016) and hospitalization (4.6±0.9 vs 4.3±0.6 days, p=0.005) were performed in the RSPM group, but the difference in hemoglobin (2.5±1.0 vs 2.6±0.9 g/dL) before and after surgery was not significant.

Limitations, reasons for caution
All surgeries underwent using the da Vinci systems by one gynecologic surgeon who had experience performing almost 2,000 gynecologic robotic surgeries and the follow-up period was not enough to conclude the reproductive outcome.

Wider implications of the findings
The RSPM using the da Vinci® SP surgical system could be recommended for patient who planned future pregnancy. However, the optimal surgical technique should be selected for successful fertility preservation of reproductive surgery.

Trial registration number
2023-03-038