Clinical experience of robotic myomectomy for fertility preservation using preoperative magnetic resonance imaging predictor
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
ObjectiveThis study aimed to demonstrate the use of preoperative magnetic resonance imaging (MRI) findings to selectthe optimal surgical technique between single-site (SS) and multi-site (MS) robotic myomectomy based on clinicalexperience, for the preservation of fertility. MethodsNinety-eight patients who underwent SS or MS robotic myomectomy using the da Vinci® Si system after undergoingMRI were evaluated retrospectively. The correlation between preoperative MRI findings and the intraoperative orpostoperative findings during robotic myomectomy for the preservation of fertility was analyzed. The reproductiveoutcome was investigated when the patient wished to conceive. ResultsThe mean age of the patients was 35.68±5.04 years and 80 patients (81.6%) were nulliparous. The total diameterof myomas on MRI was 106.75±54.52 mm. The number of resected myomas was 4.31±4.39 (range, 1–27), and thetotal weight of resected myomas was 293.11±281.13 (range, 30–1,260) g. Myomas with high signal intensity on MRIrequired less time for resection. MS robotic myomectomy was performed for an increased number and total diameterof a myoma or a deep-seated myoma. Postoperatively, all patients resumed normal menstruation. Of the 15 patientswho wished to conceive, 12 (80%) conceived successfully. Of these, uterine dehiscence occurred in 1 patient and 10patients underwent an uneventful cesarean section. ConclusionSS or MS robotic myomectomy can be recommended for patients who wish to conserve fertility. However, theoptimal surgical technique should be selected based onpreoperative MRI findings to predict an effective surgicalprocess and the successful preservation of fertility.
Abstract
ObjectiveThis study aimed to demonstrate the use of preoperative magnetic resonance imaging (MRI) findings to selectthe optimal surgical technique between single-site (SS) and multi-site (MS) robotic myomectomy based on clinicalexperience, for the preservation of fertility. MethodsNinety-eight patients who underwent SS or MS robotic myomectomy using the da Vinci® Si system after undergoingMRI were evaluated retrospectively. The correlation between preoperative MRI findings and the intraoperative orpostoperative findings during robotic myomectomy for the preservation of fertility was analyzed. The reproductiveoutcome was investigated when the patient wished to conceive. ResultsThe mean age of the patients was 35.68±5.04 years and 80 patients (81.6%) were nulliparous. The total diameterof myomas on MRI was 106.75±54.52 mm. The number of resected myomas was 4.31±4.39 (range, 1–27), and thetotal weight of resected myomas was 293.11±281.13 (range, 30–1,260) g. Myomas with high signal intensity on MRIrequired less time for resection. MS robotic myomectomy was performed for an increased number and total diameterof a myoma or a deep-seated myoma. Postoperatively, all patients resumed normal menstruation. Of the 15 patientswho wished to conceive, 12 (80%) conceived successfully. Of these, uterine dehiscence occurred in 1 patient and 10patients underwent an uneventful cesarean section. ConclusionSS or MS robotic myomectomy can be recommended for patients who wish to conserve fertility. However, theoptimal surgical technique should be selected based onpreoperative MRI findings to predict an effective surgicalprocess and the successful preservation of fertility.
참고문헌 (26)
- Stewart EA, "Uterine fibroids", Lancet, 357, pp.293~298 (2001)
- Karlsen K, "Uterine fibroids increase time to pregnancy : a cohort study", Eur J Contracept Reprod Health Care, 25, pp.37~42 (2020)
- 김현경, "Is robot-assisted laparoscopic myomectomy limited in multiple myomas?: a feasibility for ten or more myomas", Obstetrics & Gynecology Science, 61(1), pp.135~141 (2018), 대한산부인과학회[DOI]
- Kim M, "Robotic single-site myomectomy : a single-center experience of 101 consecutive cases", Int J Med Robot, 15, pp.e1959~ (2019)
- Dueholm M, "Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas", Am J Obstet Gynecol, 186, pp.409~415 (2002)
- Jondal DE, "Uterine fibroids: correlations between MRI appearance and stiffness via magnetic resonance elastography", Abdom Radiol(NY), 43, pp.1456~1463 (2018)
- Wang T, "Robotic-assisted vs. laparoscopic and abdominal myomectomy for treatment of uterine fibroids : a meta-analysis", Minim Invasive Ther Allied Technol, 27, pp.249~264 (2018)
- Huberlant S, "Fertility and obstetrical outcomes after robot-assisted laparoscopic myomectomy", Int J Med Robot, 16, pp.e2059~ (2020)
- Pitter MC, "Fertility and symptom relief following robot-assisted laparoscopic myomectomy", Obstet Gynecol Int, 2015, pp.967568~ (2015)
- Pitter MC, "Pregnancy outcomes following robot-assisted myomectomy", Hum Reprod, 28, pp.99~108 (2013)
- 최수현, "Robotic-assisted laparoscopic myomectomy: the feasibility in single-site system", Obstetrics & Gynecology Science, 62(1), pp.56~64 (2019), 대한산부인과학회[DOI]
- Lewis EI, "Robotic single-site myomectomy : initial report and technique", Fertil Steril, 103, pp.1370~1377.e1 (2015)
- Nam SH, "A comparison between reduced-port robotic surgery and multiport robot-assisted laparoscopy for myomectomy", Eur J Obstet Gynecol Reprod Biol, 213, pp.53~57 (2017)
- Moawad GN, "Comparison between single-site and multiport robot-assisted myomectomy", J Robot Surg, 13, pp.757~764 (2019)
- Goebel K, "Women’s preference of cosmetic results after gynecologic surgery", J Minim Invasive Gynecol, 21, pp.64~67 (2014)
- Yeung PP Jr, "Patient preferences of cosmesis for abdominal incisions in gynecologic surgery", J Minim Invasive Gynecol, 20, pp.79~84 (2013)
- Choi EJ, "Robotic single-site myomectomy : clinical analysis of 61 consecutive cases", J Minim Invasive Gynecol, 24, pp.632~639 (2017)
- Moon HS, "The comparison of robotic single-site surgery to single-port laparoendoscopic surgery for the treatment of advancedstage endometriosis", J Laparoendosc Adv Surg Tech A, 28, pp.1483~1488 (2018)
- Maciel C, "Preprocedural MRI and MRA in planning fibroid embolization", Diagn Interv Radiol, 23, pp.163~171 (2017)
- Park H, "Scaled signal intensity of uterine fibroids based on T2-weighted MR images : a potential objective method to determine the suitability for magnetic resonance-guided focused ultrasound surgery of uterine fibroids", Eur Radiol, 25, pp.3455~3458 (2015)
- Lénárd ZM, "Uterine leiomyomas : MR imaging-guided focused ultrasound surgery--imaging predictors of success", Radiology, 249, pp.187~194 (2008)
- Sutton C, "Spontaneous uterine rupture in a preterm pregnancy following myomectomy", Case Rep Obstet Gynecol, 2016, pp.6195621~ (2016)
- Bernardi TS, "Laparoscopic myomectomy : a 6-year follow-up single-center cohort analysis of fertility and obstetric outcome measures", Arch Gynecol Obstet, 290, pp.87~91 (2014)
- Buckley VA, "Laparoscopic myomectomy : clinical outcomes and comparative evidence", J Minim Invasive Gynecol, 22, pp.11~25 (2015)
- Flyckt RL, "Uterine rupture after laparoscopic myomectomy", J Minim Invasive Gynecol, 22, pp.921~922 (2015)
- 김희선, "Uterine rupture in pregnancies following myomectomy: A multicenter case series", Obstetrics & Gynecology Science, 59(6), pp.454~462 (2016), 대한산부인과학회[DOI]