Implementation of robot-assisted myomectomy in a large university hospital: a retrospective descriptive study

Background

Background: Myomectomy is often the preferred treatment for symptomatic patients with myomas who wish to preserve their fertility, with a shift from open surgery towards minimally invasive techniques.

Objectives

Retrospective study assessing patient and surgery characteristics, follow-up, and outcomes of robot-assisted myomectomy (RAM) and abdominal myomectomy (AM) in women treated between January 1, 2018, and February 28, 2022, in a Belgian tertiary care hospital.

Materials and Methods

A descriptive analysis was conducted on consecutive patients who underwent myomectomies. 2018 was considered the learning curve for RAM.

Main outcome measures

We assessed rate of open surgery, operation time, postoperative hospital stay, and operative complications.

Results

In total, 94 RAMs and 15 AMs were performed. The rate of AMs was 56.5% in 2018 versus 2.3% after the learning curve. The median operation time for RAM was 136.5 minutes and 131 minutes for AM. Conversion rate for RAM was 0%. The median postoperative hospital stay after RAM was 1 night and 4 nights for AM. Postoperative complication rate was low, with only 14.9% and 33.3% of patients requiring pharmacological treatment of complications after RAM or AM, respectively. No surgical re-intervention was needed in any group.

Conclusions

Implementation of RAM at our centre resulted in a significant reduction of open surgery rate. RAM demonstrated shorter hospital stays and a lower incidence of complications compared to AM.

What is new?

Our study highlights the successful adoption of RAM, showcasing its potential to replace AM even in complex cases. The findings affirm the safety and feasibility of RAM, supporting its use as a valuable technique for minimally invasive myomectomy.

The 'chicken-egg-model': a simple in vitro model for 3D-ultrasonography and elastography

Background

Three-dimensional ultrasound (3D-ultrasound) and elastography are imaging techniques facilitating the diagnosis of gynaecological diseases and uterine anomalies. These non-invasive ultrasound applications may be of important added diagnostic value in gynaecological ultrasonography.

Objectives

The main objective of this study was to develop a simple and cheap in vitro model for elastography and 3D-ultrasound, with an adaptable probe-target distance. The target should be visible within the model and its hardness should be modifiable. The orientation and inclination of the model should also be adjustable.

Materials and Methods

We used a boiled chicken egg in a gel basis as this mimics the elastic properties of human tissues. Different boiling times were compared with the stiffness at elastography. Both 3D-ultrasonography and strain elastography were conducted with a Voluson™ E10 4-9 MHz vaginal probe.

Results

Altering the eggs' boiling times modulates the levels of stiffness, and hence the aspect on elastography.

Conclusions

Our model can help trainees to practice acquisition and interpretation of elastography images. This cheap and easy-to-reproduce, in vitro "chicken-egg-model" allows for education and training of 3D-ultrasound and elastography, without causing discomfort to patients.

What is new?

We created a cheap and easy to reproduce in vitro model for the education of 3D-ultrasound and elastography.

Hysteroscopic management of caesarean scar defects

A caesarean section may lead to a defect of the myometrium at the site of the uterine scar. The association with abnormal uterine bleeding or impaired fertility has been demonstrated. Hysteroscopic remodelling reportedly reduces the symptoms. To review the available literature reporting on hysteroscopic treatment of these defects in symptomatic women with abnormal uterine bleeding or impaired fertility. A systematic search of PubMed and Cochrane databases has been performed until January 2021, including 27 articles. Hysteroscopic remodelling relieved symptoms of abnormal uterine bleeding in 60-100% and 25-100% of women with impaired fertility conceived within the follow up period. No major complications were reported. Hysteroscopic remodelling seems a treatment option in the management of symptomatic caesarean scar defects. Long-term follow-up and larger studies are needed to evaluate the effect on abnormal uterine bleeding as well as on reproductive outcomes.