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Robotic myomectomy for large fibroids

Updated: Mar 26



Welcome to our comprehensive guide on robotic myomectomy, an innovative and minimally invasive surgical approach designed for the effective removal of uterine fibroids. This advanced technique stands out as a superior alternative to traditional open myomectomy (abdominal myomectomy), particularly for fibroids smaller than 10 cm.


Robotic myomectomy not only offers a lower risk of complications for many patients but also paves the way for a significantly shorter hospital stay. Moreover, it enables a faster recovery time, allowing patients to return to their daily routines within just two to three weeks. Through this article, we aim to provide you with a thorough understanding of private myomectomy for fibroids as a pivotal treatment, highlighting the technological advancements that make robotic myomectomy a preferred choice for those seeking a minimally invasive solution in their private treatment for fibroids in London.


What size fibroid is needed for robotic myomectomy  


The ideal size for a fibroid to be considered for robotic myomectomy typically should not exceed 10 cm for a solitary fibroid, especially if it's located in an accessible position, such as the anterior side, top or the posterior border of the uterus. Additionally, the collective size of multiple fibroids ideally should not surpass 10 centimetres in total. For instance, three fibroids measuring 3, 4, and 3 centimetres, respectively, are manageable. However, if there are two fibroids, each should ideally not be more than 5 centimetres, keeping the total size to 10 centimetres or less. 


This is because when dealing with multiple fibroids, the surgery's complexity increases, making it more challenging due to varying sizes and locations. Larger or more numerous fibroids can make the procedure technically more demanding, potentially leading to longer anaesthesia time, increased risk of needing a blood transfusion, and a higher likelihood of surgical complications.


What type of myomectomy is best for a large fibroid?


Choosing the best type of myomectomy for a large fibroid involves a careful consideration of various factors including the fibroid's size, location, and number, as well as the patient's personal preferences and overall health condition. Myomectomy procedures, ranging from open surgery to minimally invasive techniques such as laparoscopic or robotic surgery, offer different benefits and challenges that need to be balanced according to each unique case.


For large fibroids, both open and keyhole (laparoscopic or robotic) myomectomies have their merits. The decision often hinges on the fibroid's characteristics: its mass, specific location within the uterus, and whether it's a single fibroid or multiple fibroids. These factors directly influence the surgical approach, determining whether a more invasive open surgery or a minimally invasive technique is advisable. 


Patients' individual wishes and health profiles also play a crucial role in this decision. Some may prioritise a faster recovery, which is often associated with minimally invasive methods, despite potentially longer anaesthetic times required for complex cases. Others might opt for an open myomectomy, accepting a slightly longer recovery period but benefiting from shorter anaesthetic time, especially if their condition, such as previous surgeries, high BMI, or specific health issues, which may make minimally invasive surgery less favourable.


The overarching message in fibroid management is that there is no one-size-fits-all solution. Each patient's situation is unique, making personalised treatment plans essential. Surgeons must consider all aspects of the patient's condition and preferences, ensuring the chosen myomectomy approach offers the safest and most effective outcome. In essence, the best type of myomectomy for a large fibroid is one that is tailored to the individual's specific needs, reflecting the complex interplay of the fibroid's characteristics, the patient's health, and their personal treatment goals.


Can fibroids be removed robotically?


Yes, fibroids can indeed be removed robotically through a surgical procedure known as robotic myomectomy. A robotic myomectomy is a minimally invasive technique that uses advanced robotic technology to assist surgeons in the precise removal of uterine fibroids. This method employs a robotic system, which includes a camera and small, precise instruments that the surgeon controls via a console.


It's important to clarify that although the procedure is termed "robotic," it is not performed by an autonomous robot. Instead, a highly skilled surgeon operates the robotic system. The surgeon sits at a console equipped with controls that direct the robotic arms and instruments. The system translates the surgeon's hand movements into smaller, more precise movements of the instruments inside the patient's body. The camera provides the surgeon with a high-definition, 3D magnified view of the surgical site, enhancing visibility and precision during the fibroid removal.


The robotic myomectomy allows for greater precision, flexibility, and control than traditional surgical methods, potentially leading to less pain, minimal scarring, and a quicker recovery for the patient. Despite the advanced technology involved, the success of the procedure heavily relies on the expertise and skill of the surgeon controlling the robotic system. This approach combines the benefits of minimally invasive surgery with the surgeon's ability to make precise movements and decisions, ensuring that each procedure is tailored to the patient's specific needs.


What is the recovery time for robotic fibroid removal?


The recovery time for robotic fibroid removal, also known as a robotic myomectomy, is generally shorter and smoother compared to traditional open surgery methods. This improvement in recovery is largely due to the minimally invasive nature of the robotic procedure, which avoids the need for large incisions. Provided that the patient is in good health, the operation proceeds without complications, and there are no issues such as infection or heavy bleeding during or after the surgery, the recovery process is typically more straightforward.


Patients undergoing robotic fibroid removal can often expect to leave the hospital within a couple of nights following the procedure. This quick hospital discharge is possible because the smaller incisions used in robotic surgery lead to less pain and reduced risk of infection, facilitating a faster healing process. Once home, patients generally experience less discomfort and are able to return to normal daily activities more quickly than those recovering from open surgery.


However, the exact recovery time can vary based on several factors, including the individual's overall health, the size and number of fibroids removed, and how one's body responds to surgery. While some patients may feel significantly better and return to light activities within a week or two, others may require a bit more time for a full recovery. It's important for patients to follow their surgeon's specific post-operative care instructions, including guidelines on physical activity, to ensure a safe and efficient healing process.


In summary, while the recovery experience can vary from person to person, the advanced technology used in robotic myomectomy typically allows for a faster and smoother recovery period, with many patients able to resume their normal routines within a few weeks post-surgery.


Robotic myomectomy for large fibroids


Fibroids, benign tumours that grow in or on the uterus, can vary greatly in size and impact on a woman's health. While small fibroids often cause little to no symptoms, larger fibroids can lead to significant discomfort, heavy menstrual bleeding, and other reproductive issues. Traditional surgical methods for removing large fibroids have been effective but come with significant drawbacks, such as longer recovery times and more substantial scarring. Enter robotic myomectomy, a cutting-edge, minimally invasive procedure that is transforming the treatment landscape for patients suffering from large fibroids.


Robotic myomectomy utilises state-of-the-art robotic technology to assist surgeons in removing fibroids with unparalleled precision and control. This approach allows for smaller incisions compared to traditional surgery, which in turn can lead to reduced pain, minimal scarring, and a faster return to daily activities for patients. The robotic system enhances the surgeon's ability to navigate complex procedures with a high degree of dexterity and visibility, making it especially suitable for the removal of large fibroids that may be difficult to address with conventional methods.


This advanced surgical technique is not only about the innovative technology but also about the patient-centric approach it enables. By offering a less invasive option with a potentially quicker recovery, robotic myomectomy represents a significant shift towards prioritising patient comfort and outcomes. It's a preferred option for many patients, particularly those who are keen to preserve their fertility or who wish to avoid the longer recovery periods associated with traditional surgery.


Robotic myomectomy stands out as a modern solution for the treatment of large fibroids, offering patients a combination of advanced surgical precision, reduced recovery time, and improved overall outcomes. As we delve deeper into the benefits and considerations of this procedure, it's clear why it has become a favoured option for both patients and surgeons alike in the management of fibroid-related symptoms.


Why choose robotic myomectomy for treating large fibroids?


The decision to opt for robotic myomectomy for the treatment of large fibroids is driven by several compelling advantages that this advanced surgical method offers over traditional approaches. Here's a closer look at the key reasons why robotic myomectomy is increasingly becoming the preferred choice for both patients and healthcare providers:


Enhanced precision and safety


The robotic system provides surgeons with a magnified, 3D high-definition view of the surgical site and fine instruments that mimic the movements of the human hand but with a greater range of motion. This increased precision is particularly beneficial when removing large fibroids, which may be intricately intertwined with surrounding tissues and organs. The enhanced visibility and accuracy help in meticulously excising the fibroids while preserving the integrity of the uterine tissue, which is crucial for women considering future pregnancies.


Minimally invasive approach


Unlike traditional open surgery that requires large incisions, robotic myomectomy is performed through a few small incisions in the abdomen. This minimally invasive approach significantly reduces the trauma to the body, leading to less post-operative pain and a lower risk of infection. The smaller incisions also mean that the aesthetic outcomes are much better, with minimal scarring.


Reduced pain and quicker recovery


Patients undergoing robotic myomectomy often experience less post-operative pain and discomfort, allowing for a quicker return to normal activities. The reduced pain is attributed to the smaller incisions and the precise, gentle handling of the tissues during surgery. Most patients can leave the hospital sooner than those who undergo traditional surgery, and they can return to their daily routines, including work, within a few weeks as opposed to months.


Lower risk of complications


The precision and control afforded by the robotic system help in significantly lowering the risk of complications such as excessive blood loss and damage to surrounding tissues. This is particularly important for patients with large fibroids, where the complexity of the surgery increases the risk of such complications.


Preservation of uterine function


For women of reproductive age who wish to maintain their fertility, robotic myomectomy offers a great advantage by allowing for the precise removal of fibroids while causing minimal disruption to the surrounding uterine tissue. This careful preservation of the uterus is essential for maintaining fertility and the ability to carry a pregnancy to term.


Patient-centred care


Robotic myomectomy aligns with the principles of patient-centred care by focusing on minimising discomfort, reducing recovery time, and improving surgical outcomes. This approach not only addresses the physical removal of fibroids but also considers the overall well-being and future health of the patient.


The decision to choose robotic myomectomy for the treatment of large fibroids is driven by its numerous benefits, including surgical precision, a minimally invasive approach, reduced recovery times, and the preservation of fertility. These advantages make it a compelling option for patients seeking effective, safe, and patient-friendly treatment for large fibroids.


The risks associated with robotic myomectomy: what patients should know


While robotic myomectomy offers significant benefits for the removal of large fibroids, as with any surgical procedure, it is not without its risks and potential complications. It's crucial for patients to be well-informed about these risks to make educated decisions regarding their treatment options. Below are the key risks associated with robotic myomectomy:


Surgical complications


Although less common than in traditional open surgery, there is still a risk of bleeding during a robotic myomectomy that may require a blood transfusion or, in rare cases, converting to an open surgical procedure to control the bleeding.


Any surgery that involves incisions carries a risk of infection, though the risk is minimised in robotic surgery due to smaller incisions and less tissue disruption.


The uterus is closely surrounded by other vital organs, including the bladder and intestines. While the precision of robotic surgery reduces the likelihood, there's still a risk of accidental injury to these organs. However, such injuries are often small, recognised and repaired instantly during the operation. 


Anaesthetic risks


As with any procedure requiring general anaesthesia, there are risks associated with the administration of anaesthesia, including allergic reactions, breathing difficulties, and heart and blood pressure problems. These risks are generally low and are carefully managed by the anaesthetic team.


Conversion to open surgery


In some cases, the surgeon may need to convert the robotic procedure to an open surgery if there is difficulty in safely completing the operation using the robotic system. This may be due to the size or location of the fibroids, unexpected complications, or poor visibility.


Postoperative complications


Scar tissue can form following any surgery, potentially leading to adhesions that might cause pain or fertility issues. Robotic surgery tends to result in fewer adhesions compared to open surgery due to the minimally invasive approach.


While recovery from robotic myomectomy is typically quicker, complications like infections or poor wound healing can extend recovery times. It's possible for new fibroids to develop after surgery, which could necessitate further treatment.


Fertility and pregnancy risks


Robotic myomectomy is often chosen to preserve fertility. However, any surgery on the uterus carries the risk of affecting fertility and pregnancy. Changes to the uterine wall and integrity might impact future embryo implantation, and scar tissue could affect uterine stretching during pregnancy. Additionally, women who have undergone a myomectomy may be advised to deliver via caesarean section to avoid the risk of uterine rupture during vaginal birth.


Psychological impact


Surgical treatment for fibroids can also have a psychological impact, including anxiety about the surgery, recovery, and the impact on fertility and future health. Support and counselling may be beneficial for some patients.


It's important for patients considering robotic myomectomy to discuss these risks in detail with their healthcare provider, who can provide personalised information based on the patient's health history, the size and location of the fibroids, and other factors.

Understanding these risks is a crucial step in making an informed decision about undergoing robotic myomectomy for the treatment of large fibroids.


Preparing for your robotic myomectomy at Rylon Clinic: A comprehensive guide


Undergoing a robotic myomectomy is a significant step towards addressing the discomfort and health issues caused by large fibroids. To ensure the best possible outcomes and a smooth recovery, thorough preparation is essential. Here is a comprehensive guide to help you prepare for your robotic myomectomy at Rylon Clinic:


Before your surgery


Medical evaluations and tests


Preoperative assessment: you'll undergo a detailed preoperative assessment, which may include blood tests, imaging studies (like an MRI or ultrasound), and a physical examination to help your surgical team plan the procedure.


Consultation: discuss any concerns or questions you have with your surgeon. Be sure to inform them about all medications, supplements, and herbal treatments you are taking.


Medication adjustments


If you're on blood-thinning medications, you may need to stop or adjust these before surgery to reduce the risk of bleeding. Your healthcare provider will give you specific instructions based on your situation.


Inform your doctor about all medications you're taking, as some may need to be temporarily adjusted or stopped, especially those that can affect blood clotting or interact with anaesthesia.


Dietary restrictions


Follow any dietary restrictions provided by your doctor, such as fasting from midnight the day before your surgery. You'll usually be advised not to eat or drink anything, including water, after this time. Stay well-hydrated in the days leading up to your surgery, but adhere to any restrictions on the intake of liquids as your surgery date approaches.


Lifestyle preparations


If you smoke, try to quit or reduce smoking as it can affect your recovery. Also, avoid alcohol a week before your surgery, as it can increase the risk of bleeding. Maintain a healthy level of activity as recommended by your doctor. This can help with your post-surgery recovery.


The day before surgery


Arrange for someone to drive you to the hospital and pick you up after your surgery, as you will not be able to drive yourself. Pack a bag- include items you might need during your hospital stay and when you return home, such as a list of medications, personal hygiene items, comfortable clothing, and any specific items recommended by your doctor.


The day of surgery


Shower using antibacterial soap if advised by your surgeon, but avoid applying lotions, perfumes, or makeup. Wear loose, comfortable clothing that is easy to put on and take off after the surgery. Leave jewellery and other valuables at home.


Final preparations


Check-in: Arrive at the hospital or clinic at the scheduled time to complete any necessary paperwork and pre-surgical procedures.


Relaxation techniques: Practise relaxation techniques if you're feeling anxious. Deep breathing, meditation, or listening to calming music can be beneficial.


By following these pre-operative instructions carefully, you can help ensure that your robotic myomectomy at Rylon Clinic goes as smoothly as possible, paving the way for a successful surgery and a swift recovery.


The robotic myomectomy procedure: step-by-step


Understanding the procedural steps of a robotic myomectomy can significantly ease the anxiety many patients feel before surgery. Here’s a detailed walkthrough of what happens during the operation, from the initial anaesthesia to the final stages of fibroid removal.


Anaesthesia administration


The procedure begins with the administration of general anaesthesia, ensuring you're asleep and free of pain throughout the surgery. An anaesthetist will monitor your vital signs and manage your comfort levels during the entire procedure.


Preparing the abdominal area


Once the anaesthetic takes effect, the surgical team prepares the abdominal area by cleaning and sterilising the skin to reduce the risk of infection. This preparation is crucial for a safe surgical environment.


Making the incisions


The surgeon makes a few small incisions in your abdomen. These incisions are typically less than 1.5 cm each and serve as entry points for the surgical instruments and a high-definition camera. The camera will provide the surgeon with a magnified view of your internal organs and the fibroids.


Inserting the robotic instruments


After the incisions are made, the surgeon inserts the robotic instruments and the camera into your abdomen. The surgeon then moves to a console in the operating room to control these instruments. The console provides a 3D high-definition view of the inside of your abdomen, allowing the surgeon to perform the procedure with enhanced precision and dexterity.


Inflating the abdomen


To improve visibility and give the surgeon more room to work, the abdomen is inflated with carbon dioxide gas. This elevation provides a clear view and safe access to the uterus and the fibroids.


Removing the fibroids


Using the robotic instruments, the surgeon carefully cuts away the fibroids from the uterine wall. The precision of the robotic system allows for meticulous removal of the fibroids while minimising damage to the surrounding uterine tissue, which is particularly important for preserving fertility and uterine function.


Repairing the uterus


After the fibroids have been removed, the surgeon repairs the uterus with stitches. The robotic system's precision is crucial in this step, ensuring that the uterine wall is restored as closely as possible to its natural state, which is important for healing and future pregnancies.


Removing the surgical instruments


Once the fibroids are removed and the uterus is repaired, the surgeon removes the robotic instruments and camera from your abdomen. The incisions are then closed with stitches, surgical glue, or staples, and dressed to promote healing.


Post-procedure care


After the procedure is completed, you will be moved to a recovery area where your vital signs are monitored as you wake up from the anaesthetic. Pain management, recovery expectations, and follow-up care will be discussed with you and your caretaker before you are discharged.


Recovery and aftercare: navigating the path to wellness post-myomectomy


Recovering from a robotic myomectomy involves several stages, each critical for ensuring a smooth transition back to health and wellness. Here, we'll explore what you can expect during the recovery process, including pain management, activity restrictions, follow-up appointments, and general tips for a successful recovery.


Pain management


After the procedure, it's normal to experience some discomfort and pain, which can typically be managed with prescribed medication. Your healthcare provider will advise you on how to effectively manage pain, which may include a combination of over-the-counter pain relievers and prescription medications. It's important to follow the dosage instructions carefully and communicate with your care team about how effectively the pain is being managed.


Activity restrictions


To ensure a smooth recovery, you'll need to follow specific activity restrictions:


Rest: prioritise rest in the first few days post-surgery to allow your body to begin the healing process. 


Gradual increase in activity: slowly increase your activity level based on your doctor's advice. Light walks can aid circulation and prevent blood clots, but avoid strenuous activities and heavy lifting for the time recommended by your surgeon.


Driving: you should avoid driving until you are off prescription pain medication and can move comfortably, which typically takes about two weeks.


Work: Depending on the nature of your job, you may be able to return to work within 2-4 weeks. Jobs that require physical exertion may require a longer recovery period.


Follow-up appointments


Follow-up appointments are crucial to monitor your recovery and ensure that the surgical site is healing properly. During these visits, your surgeon will check for any signs of infection, assess your pain management plan, and answer any questions you may have. These appointments are also an opportunity to discuss when you can resume normal activities, including sexual activity and exercise.


Tips for a smooth recovery


Drink plenty of fluids and eat a balanced diet rich in vitamins and minerals to support healing. Foods high in fibre can help prevent constipation, which is common after surgery. Follow your surgeon's instructions for caring for your incisions, which may include keeping the area clean and dry and monitoring for signs of infection. Enlist the help of friends and family for assistance with tasks that may be difficult in the initial stages of recovery, such as cooking, cleaning, and shopping. It's common to experience a range of emotions after surgery. If you're feeling overwhelmed, consider seeking support from a counsellor or support group.


Long-term care


After recovery, regular follow-ups may be recommended to monitor for the recurrence of fibroids and assess your overall reproductive health. Maintaining a healthy lifestyle, including regular exercise and a balanced diet, can also contribute to your long-term well-being.


Recovery from a robotic myomectomy varies for each individual, but understanding what to expect and following your healthcare provider's instructions can significantly enhance your recovery experience. Remember, every step taken post-surgery is a step towards regaining your health and returning to your daily life.


Conclusion


Robotic myomectomy represents a significant advancement in the treatment of large fibroids, offering patients a minimally invasive option that combines the benefits of reduced pain, quicker recovery times, and minimal scarring with the precision and effectiveness of traditional surgery. From understanding the procedure and its benefits to preparing for surgery and navigating through recovery, patients are equipped with the knowledge and support needed to make informed decisions about their health.


As healthcare continues to evolve, procedures like robotic myomectomy underscore the importance of technological innovation in improving patient outcomes. However, it's equally important for patients to be aware of the risks and the recovery process to set realistic expectations and actively participate in their path to wellness.


For those considering or preparing for a robotic myomectomy, it's crucial to engage in open and honest communication with your healthcare provider, adhere to pre- and post-operative instructions, and focus on your recovery and well-being. With the right preparation and support, patients can look forward to a successful surgery and a smoother recovery, moving closer to relief from the symptoms caused by large fibroids and towards a healthier future.


Rylon Clinic is committed to providing world-class clinical excellence for our patients, incorporating the latest advancements in medical technology with a patient-centred approach. We believe in empowering our patients with knowledge and supporting them every step of the way, from initial consultation to full recovery.



Author: Mr Osama Naji


Mr Naji offers a “one-stop” gynaecology clinic for instant detection of various gynaecological cancers as well as providing all the diagnostic and treatment services needed under one roof.



Mr Naji provides advanced gynaecology scanning which is essential when conducting any gynaecology consultation, he is bilingual in English and Arabic and has an NHS base at the highly reputable Guy's and St Thomas' Hospital in London.

He is passionate about raising awareness of various subtle signs and symptoms of gynaecological conditions that are often overlooked by patients.

You can read more about Mr Naji on his about page here.


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