Lack of Haptic Feedback Is Replaced by More Developed Visual Sense during Robotic Myomectomy

In the reproductive age group, many women have several uterine myomas that present with abnormal uterine bleeding, low abdominal discomfort, and occasionally infertility [1]. Clinically, asymptomatic uterine myomas are diagnosed in 25% to 40% of all women and the incidence of myomas increases with age [1]. Although uterine myomas tend to have no positive influence on fertility, myomectomy is considered to maintain fertility. There are three types of surgical approach to perform myomectomy, including robotic-assisted, laparoscopic, and abdominal myomectomy. These surgical approaches have different advantages and disadvantages regarding patient recovery and fertility [2]. In performing myomectomy, uterine scar repair is the most important factor affecting fertility outcomes. With open myomectomy procedures, most myomas can be removed by palpating uterine walls. However, patients suffer more from postoperative wound pain and have a large scar. To avoid postoperative pain, patients often desire minimally invasive surgeries even with multiple large myomas. Other minimally invasive surgical techniques include laparoscopic or robotassisted laparoscopic myomectomy [2]. However, in laparoscopic myomectomy, it is difficult to approach the deep base origins of large myomas. It is also difficult to perform layer-by-layer sutures of the uterine wall and remove tiny and deep seated myoma nodules. Compared to laparoscopic procedures, robotic myomectomy uses fine wristed instruments with more magnification to allow approach of various myoma bases, performance Case Report Ewha Med J 2019;42(2):20-23 https://doi.org/10.12771/emj.2019.42.2.20 eISSN 2234-2591