Overcoming the limitations of single-site robotic myomectomy via the gradual turning out method without an accessory port, and a know-how

Robotic surgery has advantages in myomectomies, which are a technically complex surgery. Multi-site robotic myomectomy (MRM) is widely used and is a safe, minimally invasive surgery. Single-site robotic myomectomy (SSRM) is further expected to provide potential advantages such as better cosmesis and easier fibroid removal. Compared with MRM, SSRM has technical limitations, including a restricted range of motion, especially for large-sized myomas; less powerful suturing in thick myometrium; and non-articulating instruments. To overcome these limitations, additional ports are used, larger skin incisions are made, and the procedure is combined with laparoscopy. However, these adjustments may neutralize the advantages of a single-port surgery. Here we describe our novel gradual turning out method, which enables us to do SSRM without adjustments. Additionally, we introduce know-how on how to accomplish an SSRM.