Robotic myomectomy is a procedure to remove myofibroids, which are common growths in the uterus. These tumors do not cause cancer, but are associated with an increased risk of other types of cancer in the uterus. These tumors are called leiomyomas. The cause of leiomyomas is not fully understood, but hormonal factors such as estrogen are thought to play an important role in their development.
It is one of the most common benign tumors in women. It affects approximately 20% to 30% of women of childbearing age, and women of African or African-American descent are 2-3 times more likely to be affected than women of other ethnicities. Between 20% and 30% of patients may require surgical intervention.
What is a uterine leiomyoma?
Uterine fibroids (or leiomyomas) are non-cancerous growths that develop within the uterus of varying size in the tissues and muscles within or on the uterus wall. These tumors are generally benign and harmless, and women often don’t realize they have uterine leiomyomas due to the lack of symptoms. Sometimes these tumors can cause symptoms such as pain, heavy and irregular vaginal bleeding, and the frequent need to urinate. In rare cases, complications caused by tumors can affect pregnancy or cause infertility.
What are the types of uterine leiomyomas?
- Intramural smooth muscle uterine tumors: These tumors develop in the muscular inner wall of the uterus and are very common.
- Subserosal smooth uterine tumors: These tumors develop in the outer wall of the uterus and extend into the pelvis, and can become large and cause a feeling of fullness.
- Submucosal smooth muscle uterine tumors: These tumors develop under the inner lining of the uterus.
- Pedunculated smooth uterine tumors: These tumors are associated with a thin stem, which is less common.
What is robotic myomectomy for uterine myoma?
Robotic myomectomy is an operation performed using an advanced surgical robot (such as Da Vinci) where the surgeon controls the robot from a special unit that provides magnified 3D vision, precision instruments that move more freely than the human hand, and ultra-precise motion control. Robotic myomectomy is a type of surgery to remove uterine fibroids and is a minimally invasive method that uses small cuts or incisions compared to standard (general) surgery. Robotic myomectomy was previously performed via laparotomy, but as surgical techniques have evolved, Laparoscopic Myomectomy has been introduced as a less invasive option.
Robotic myomectomy enables surgeons to remove complex or multiple fibroids through small incisions with high precision while preserving the integrity of the uterus. The advantages of robotic myomectomy are that it minimizes blood loss, causes less postoperative pain, and speeds up the recovery period compared to traditional or laparoscopic surgery.
Why is robotic myomectomy recommended for uterine myoma?
Traditional open myomectomy requires one large incision and retraction to accommodate human hands, but only small incisions are required in the abdomen for the slender robotic arms and small surgical instruments used in robotic myomectomy, due to the technical difficulties of laparoscopic myomectomy such as precise tumor resection through the appropriate anatomical level, and closing the uterine wall in several layers, laparoscopy has not been widely adopted. Especially in cases that include: the presence of multiple tumors (because it requires multiple incisions in the uterus and precise suturing), tumors in difficult locations (such as the posterior wall of the uterus, cervix), or tumors that are large in size or penetrate the uterine wall into the endometrium.
Thus, it was only natural that new and more efficient techniques, such as robotic myomectomy, were developed as an alternative to overcome these difficulties and risks.
When is robotic myomectomy the best option for a patient?
Robotic myomectomy is used when a set of conditions exist that make this type of intervention the most appropriate, it is the best option when the patient suffers from severe symptoms such as heavy and irregular uterine bleeding, chronic pelvic or back pain, pressure on the bladder or intestines, difficulty conceiving or recurrent miscarriages, and if the patient wants to preserve the uterus.
And fertility, women who are thinking of getting pregnant later can rely on this operation as an excellent option to preserve the uterus from any damage due to its extreme accuracy in suturing, which can be offered instead of traditional surgery or laparoscopic surgery due to their risks, especially if the tumor is in hard-to-reach places and the surgery needs very high precision in removing the tumor without hurting the uterus.
What are the advantages of robotic myomectomy?
The advantages of robotic myomectomy are numerous and are one of the reasons why it is the preferred choice of many doctors and patients. Some of the most important features are:
- High-precision surgery: Thanks to precise robotic instruments and wrist motion, the surgeon can reach difficult areas and remove tumors with pinpoint precision and excellent cosmetic results.
- Advanced 3D vision: Thanks to the robotic system’s camera, it can provide a very clear magnified view, which improves the performance and safety of the surgery.
- Smaller incisions and less pain: Very small incisions (typically 3-4 incisions of 1 cm) are made compared to open surgery, resulting in less post-operative pain, smaller scars, and a lower risk of infection.
- Faster recovery and a quicker return to daily life: Most patients leave the hospital the same or next day, and can return to work and activity within one to two weeks.
- Precise suturing of the uterine wall: An important feature for women who want to get pregnant after the procedure, it can help the uterus heal better and minimize the risk of future pregnancies and complications.
- Less blood loss: Thanks to precise control, there is less bleeding during the procedure and less need for blood transfusions.
- Significant improvement in symptoms: Heavy uterine bleeding disappears or improves, and pelvic pain and pressure on the bladder or rectum are relieved or eliminated.
- Minimize surgical complications: thanks to the robot’s precision in suturing the uterine wall tightly, minimizing blood loss and infection.
How is robotic myomectomy performed?
Preparations for robotic myomectomy include a series of organized medical steps to ensure patient safety and the success of the surgery, including:
Preparing the patient for the procedure through a comprehensive medical evaluation, which is a careful clinical procedure by the doctor that includes:
- An electrocardiogram (ECG) test, which checks your heart rhythm and cardiac function
- Ultrasound to create an image of the pelvis to view fibroids
- Magnetic resonance imaging (MRI), which provides detailed information about pelvic fibroids, such as their number, size, and location
- Comprehensive blood tests (check for infection, anemia, clots, and blood clotting), and check kidney and liver function
The doctor should explain the robotic myomectomy surgical plan in detail and explain the benefits, risks, and alternatives. The patient should also tell the doctor about any recent health changes, such as fever, and emphasize her desire to preserve the uterus and fertility. The patient needs to be reassured and comfortable after hearing the robotic myomectomy process, and the recovery should be explained. It requires preparation for a short period of rest at home after the operation (approximately one to two weeks).
For robotic myomectomy, the patient should tell the doctor about all medications she is taking, including regular medications, over-the-counter medications such as aspirin, and all prescription medications. It also includes herbs, vitamins, and other supplements. Your doctor may ask you to stop taking certain medications before the procedure, such as blood thinners. The patient may need to fast for hours (6 to 8 hours) before the procedure. If she is a smoker, she will need to stop before surgery, as smoking may delay healing. If she has trouble stopping, talk to her doctor about it.
Take a shower before going to surgery. Do not wear makeup, nail polish, deodorant or antiperspirant on the day of the procedure and remove all body piercings and artificial nails.
During a robotic myomectomy for uterine myoma
Robotic myomectomy is performed under general anesthesia, usually intravenously, the patient is completely asleep and a device is placed to monitor blood pressure, pulse, and oxygen. The abdominal skin is sterilized with medical antiseptics to prevent infection, and a catheter is placed in the bladder to prevent urine leakage during the procedure. The patient may be given antibiotics before and after the procedure. These devices are often removed after the procedure is completed.
Three to five very small incisions (0.5–1 cm) are made in the abdomen, usually around and below the navel. Carbon dioxide is pumped into the abdomen to help the surgeon see the tumor area better by raising the abdominal wall and creating space for surgery.
After that, a tiny camera is inserted through one of the openings and connected to a high-definition 3D projector, and the robotic surgical tools are inserted through the rest of the openings. The surgeon does not control the instruments directly but sits at a nearby console. He moves the robot’s instruments via mechanical arms that mimic his movements exactly, but with a smaller size and greater flexibility (7 degrees of freedom, just like a wrist).
Using a camera, the surgeon precisely locates the uterine myoma within the uterine muscle. The muscular membrane of the uterus above the tumor is then opened, and the tumor is gently removed without harming the surrounding tissue. If there is more than one tumor, the procedure is repeated for each one separately. The tumor is cut into small pieces if it is large and exits through one of the incisions. In some centers, a special bag is used to avoid spreading any cells.
After the tumor is removed, the uterine muscle is sutured with great precision using robotic tools. The stitching is usually multi-layered to prevent weakening of the uterine wall, especially if the patient plans to get pregnant later.
When robotic myomectomy is over, the instruments are withdrawn from the body, the gas is evacuated from the abdomen, and the small incisions are closed with a cosmetic stitch or special medical adhesive.
After robotic uterine myomectomy
After robotic myomectomy, the patient goes through several stages of recovery. These stages begin with being transferred to the recovery room, during which vital signs such as blood pressure, pulse rate, respiration and oxygen level are monitored, and if everything is stable, she is moved to her room after about an hour or two.
On the first day of the operation, the patient may feel mild to moderate abdominal pain, which can be treated with painkillers, in addition to some bloating, gas, or shoulder pain due to the air used in the surgery. The patient is encouraged to sit or walk the same day (or the next day) to avoid clots and stimulate the bowels. Clear liquids are recommended at first, and then food is gradually reintroduced depending on the degree of recovery.
The patient can often be discharged after one or two days if her condition is stable. Clear instructions are given about incision care, medications, daily activities, and follow-up appointments. The recovery period at home is one to four weeks, and you can expect some vaginal bleeding for several days after the procedure. Some fluid may leak from the incisions. Tell the hospital if there is a lot of fluid, if the fluid is bloody, or if the incisions are red or dark. The hospital should be contacted if the patient has a fever, heavy menstrual bleeding, severe pain, difficulty breathing, or other severe symptoms.
The pain gradually subsides and painkillers are generally sufficient. It is recommended to avoid strenuous sports during this period, such as heavy lifting or strenuous exercises, and to avoid marital relations throughout this period until you feel comfortable doing them. You can return to office work or light activities such as walking after one to two weeks. Incisions heal quickly due to their small size, but it is important to keep them clean and dry and watch for signs of infection (redness, discharge, heat).
The patient should attend all of her follow-up appointments with the doctor. At these follow-ups, the wound is examined to ensure proper healing of the uterus. Depending on the number, size, and location of the tumors, the patient can safely become pregnant several months after surgery.
What are the potential risks of robotic myomectomy?
Although robotic myomectomy is a safe and precise procedure, like any other operation, it may carry some risks and complications, albeit at a low rate. Some of these risks include:
Complications during the operation
You may start with an allergic reaction to the medications used and temporary issues with breathing or blood pressure. Excessive bleeding may occur if the tumors are large or heavily vascularized, and in rare cases, the patient may need a blood transfusion. Neighboring organs such as the ureter, intestines, or blood vessels may be affected. But these risks are very rare in experienced surgeons. The surgeon may find it difficult to sew up the uterus, especially if the tumors are deep or multiple.
Postoperative complications
Poor hygiene or sterilization can lead to an infection that spreads to the incisions or uterus, causing high fever, pain, or abnormal discharge. It is often treated with antibiotics. Blood clotting is a very rare complication and can be prevented by early mobilization and the use of compression stockings. The pain or swelling of the abdomen may persist for several days or weeks. Intra-abdominal adhesions, scar tissue that can cause pain or issues later, may form, but are less common in robotic surgery than in general surgery.
There are some rare but important risks, as tumors can come back because removing the tumor does not prevent new tumors from growing later. Regular follow-up is recommended, especially for those with a strong family history or hormonal disorders. Rupture of the uterus may occur in the next pregnancy (very rare), but it is possible, especially if the uterine wall sutures are not strong enough. Therefore, a cesarean delivery is often recommended in the next pregnancy.
What is the difference between robotic myomectomy and traditional surgery?
The difference between robotic myomectomy and traditional surgery lies mainly in the technique of the procedure, accuracy of execution, and recovery time. Traditional surgery is usually performed through a large abdominal incision, which means more pain, a visible scar, and a longer recovery period.
Robotic myomectomy is performed through small incisions using precision instruments controlled remotely by the surgeon, allowing fibroids to be removed with high precision while minimizing blood loss and damage to healthy uterine tissue. Three-dimensional vision and advanced instrument control provide superior precision in suturing the uterus, which improves the chances of preserving fertility. Thanks to these features, the hospital stay is shorter, post-operative pain is less, and the patient returns to normal life faster compared to traditional surgery.
How much does robotic myomectomy cost in Turkey?
The cost of robotic myomectomy ranges from approximately $2,500 to $6,000. This often includes the surgery fee, hospital cost, anesthesia, initial tests, and a one—or two-day stay after the procedure. The price varies depending on the number and size of tumors, the reputation of the hospital, the experience of the surgeon, the presence of additional services such as a translator, and hotel accommodation.
One of the things that make Turkey a favorite destination is: Robotic myomectomy may cost about $15,000-25,000 in America or in Europe (France or Germany) about $10,000-18,000, but the quality in Turkey is comparable to these countries due to the efficiency of the medical staff and the availability of the latest surgical robots (such as Da Vinci). Turkey has many internationally trained surgeons who speak English or work in multilingual teams. Low waiting time: In America and Europe, patients can wait weeks to months for an appointment. In Turkey, appointments are scheduled quickly, and the procedure can be performed in a few days.
Robotic myomectomy is an important development in the field of gynecological surgery, combining high precision and minimally invasive surgery, providing greater patient comfort and better long-term outcomes. Whether in terms of preserving fertility, reducing pain, or speeding recovery, this technique provides an effective and safe treatment option for women suffering from fibroids. With its advanced medical care and affordability, Turkey is an ideal destination for this type of procedure. Choosing the right surgeon, good preparation, and understanding what the procedure involves are all factors that contribute to a successful robotic myomectomy and the best possible outcome.
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