| Abstrakt: |
Presenting the surgical challenges in a robot-assisted myomectomy following treatment with a GnRH analog and uterine artery embolization. Case report illustrated with video. Patient under general anesthesia, placed in lithotomy position, with arms alongside the body and legs 80 degrees abducted in adjustable stirrups. We used 3 robotic arms to access the cavity: one for the optics inserted through the umbilical scar and two incisions on the right and left flanks for robotic forceps. Additionally, laparoscopic assistance was provided on the right flank. The cervix was manipulated with a disposable uterine manipulator. DTS, 26 years old, nulliparous, with reproductive desire, presenting increased abdominal volume, chronic pelvic pain, refractory dyspareunia, and increased uterine bleeding despite advanced clinical treatments such as the use of GnRH analog and uterine artery embolization. On physical examination, the uterus was enlarged, approximately 4cm above the pubic symphysis. On MRI, the uterus had a volume of 1020,9cc, due to a large posterior intramural body nodule measuring 11.2 x 10.7 x 10.4 cm. The right ovary is displaced anteriorly without alterations, and the left ovary is displaced posteriorly, with a volume of 21.1 cm³, increased due to endometriomas, the largest being 3.7 cm. Myomectomy, excision of endometriosis lesions, and oophoroplasty using robot-assisted laparoscopy. The surgery lasted 2h30, with minimal blood loss. The patient had good postoperative evolution, with no pain complaints in the postoperative period, and was discharged after 1 day. In this case, we observed the advantage of robotic surgery for fine dissection of structures, as well as the surgical ease with robotic instruments, bringing greater agility and safety to the procedure. [ABSTRACT FROM AUTHOR] |
