docRobotic Approaches to Large Fibroids and Robotic Myomectomy
download 
Report Transcription
Robotic Approaches to Large Fibroids and Robotic Myomectomy
Robotic Approaches to Large Fibroids and Robotic Myomectomy Winfred Parnell MD Incidence: • By ages 50 1. 70% Whites 2. 80% African Americans • Accounts for 33% of 600,000 Hysterectomies in U.S. • Most common solid pelvic tumor • Recurrence depends on number of tumors. 1. Single- 27% 2. Multiple- 59% Robotic vs. Laparoscopic Myomectomy 11-28% less conversion rate to open procedure Less blood loss Less pain and return normal activity sooner Perform more complicated procedures Greater ability to separate more tissue planesprecise dissection • Better ability to reconstruct uterine defect - wrist action • Less time • 3 D Image • • • • • Robotic myomectomy???? Suggested Patient Selection Criteria for 1st Five Cases • Non-obese patient • Healthy reproductive age patient with few or no co-morbidities • No previous intra-abdominal or pelvic surgery • Single, less than 5 cm, fundal subserosal myoma • Avoid using Gonadotropin Releasing Hormoneagonists (GnRH-a) due to distortion of capsule & softening of myoma Suggested Pre-Operative Evaluation Pelvic exam—Mobile, nonbulky uterus Endometrial Bx: if abnormal bleeding Sonogram: size, location and number MRI: ?? Added benefit to R/O Adenmyosis, leiomyosarcoma= Inc. LDH + cent.necrosis • Bowel Prep • Recurrence risk (27-59% premenopausal pt.) • Discuss future pregnancy and C-Section • • • • Suggested Pre-operative Evaluation In OR • • • • • DVT Prophylaxis Decompress stomach (NG tube) Antibiotic—1dose pre-op, 2doses postop Repeat bimanual Marcaine 0.5% with epinephrine at port sites Surgical Techniques • Port Placement • Side Docking • Injection Solution Vasopressin 20 IU in 60 cc normal saline • Cutting Current 30-35 watts • Barbed Suture • Avoid Entering the Endometrial Cavity • Morcellation – String Technique (Leiomyomatosis?) • Adhesion Prevention Port placement Myomectomy patient #1 • 38 y/o G1P1 B/F who presented to the office at 8 weeks gestation with 17-18 wk size uterus. Premature rupture of membranes at 19 weeks. Hospitalized and had spontaneous labor at 23weeks gestation. Vaginal breech delivery. • Breastfeeding at 4 months postpartum, 9cm fundal and 5cm post. myomas. Thank You Questions?
Similar documents
The Management of Endometrial Cancer Ellen Jones MD PhD University of North Carolina
Global Robotic X-ray Scanner Market
Robotic X-ray scanner is a medical imaging device which gives flexibility to the medical practitioner. It has got its name from its characteristic of moving according to commands given to it. This robotic X-ray scanner uses radiographic abilities and is used in fields of emergency care, critical care, orthopedic and surgical and non-surgical processes. The X-ray source and X –ray detector can move simultaneous without moving the patient. Robotic X-ray scanner comes in handy when patient is unconscious and is unable to move or respond.
