**3. Robotic myomectomy: step by step**

The first step is to have a good imaging diagnosis, with magnetic resonance imaging the ideal study at this time for this as sown in **Figure 1**. This must be interpreted correctly by the surgeon, since it is the GPS to achieve success in terms of removing the number of fibroids and planning the hysterotomy.

The second step is planning regarding the configuration of robotic ports for successful intraoperative development, taking into account the following philosophy:

In robotic myomectomy, if the objective is below the umbilical scar, we can place the robotic lens at the umbilical level. But if the objective is at the umbilical level or above it, then we need an adequate working distance of between 7 and 10 cm, depending on the case to be able to develop our work well and then the lens must be at that distance level as shown in **Figure 2**.

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shown in **Figure 4**.

**Figure 1.**

shown in **Figure 9**.

*Robotic Myomectomy: Until Achieving Reproductive Success, Step by Step*

Finally the development of the surgery step by step is as follows:

*Protocol magnetic resonance imaging for fibroids localization.*

and necrotic the myometrial tissue. As shown in **Figure 6**.

1.Infiltration of the myometrium with dilute vasopressin. As shown in **Figure 3**.

2.Incision of the myometrium with scissors or monopolar hook in arm 1 using the monopolar energy judiciously and without excess (maximum 35 Watts). As

3.Traction and countertraction technique until complete enucleation of the myoma, using a tenaculum for greater efficiency. As shown in **Figure 5**.

5.The closure of the myometrium is in three planes with preferably barbed

6.After the repaired uterus, hemostasis is verified. As shown in **Figure 8**.

4.The myometrium is observed and the intact endometrial dome is observed in the center, and we do not recommend using it as much as possible as it dries

suture that reduces operative times and reduces bleeding. As shown in **Figure 7.**

7.At the end of the uterine suture, the robot was undocked and the fibroid was extracted by using of contained electrical or not electric morcellation. As

*DOI: http://dx.doi.org/10.5772/intechopen.97880*

*Robotic Myomectomy: Until Achieving Reproductive Success, Step by Step DOI: http://dx.doi.org/10.5772/intechopen.97880*

*Latest Developments in Medical Robotics Systems*

myomatosis. It was found that regarding the comparison between the robotic and laparoscopic technique, no significant differences were found between both types of surgery. Concluding that the minimally invasive approach has the advantage of less blood loss, less need for transfusion and shorter hospital stay. Suggesting that long-term outcomes required clarification, including pain control, fertility, and

Two years later, Wang et al. They carried out a new meta-analysis on our subject

The results in functional terms after performing a myomectomy by any approach is to achieve the birth of a healthy baby. In Mexico, the first successful report on a robotassisted myomectomy was made by our surgical team [14]. However, in this area there are not such drastic conclusions about the approach in favor of one or another technique according to the superiority of its reproductive results and the absence of randomized studies that compare the different surgical approaches in this regard. However Jayakumaran in a comparative analysis of the role of robot-assisted laparoscopy in the field of reproductive surgery the reported advantages and limitations of the use of robotics in reproductive surgeries such as myomectomy, among others. He found that robotic assistance in reproductive surgery presented decreased blood loss, less postoperative pain, a shorter hospital stay, and a faster convalescence, while reproductive outcomes were similar in the other approaches. He likewise found that robotic surgery was as safe and effective as conventional laparoscopy, representing a totally reasonable alternative to the abdominal approach. He suggesting that procedures that are technically challenging with the Conventional laparoscopy could be performed with robotic assistance due to its advantages of better visualization and Endowrist™ movements (similar to the wrist of the human hand) that allow for precise suturing. This helps to overcome the limitations of laparoscopy, especially in complicated procedures, and can shorten the learning curve of minimally invasive surgery. Thus justifying the controlled and randomized studies that compare the short and long-term results to strengthen the

postoperative pregnancy rates, as well as possible recurrence rates [13].

lower conversion rate of the procedure and less operative bleeding [14].

role of robotic surgery in the field of reproductive surgery [15].

which it was compared in the study [16, 17].

**3. Robotic myomectomy: step by step**

at that distance level as shown in **Figure 2**.

Regarding efficiency with good results, fundamental characteristics in surgical procedures, there is the question that up to what number of fibroids would it be possible to remove by minimally invasive surgery?(16), particularly in robotic surgery. Kim et al. They demonstrated that it is feasible to perform a robotic myomectomy in patients with up to 20 fibroids, preserving efficiency and good postoperative results, being even a faster procedure than the open myomectomy with

The first step is to have a good imaging diagnosis, with magnetic resonance imaging the ideal study at this time for this as sown in **Figure 1**. This must be interpreted correctly by the surgeon, since it is the GPS to achieve success in terms

The second step is planning regarding the configuration of robotic ports for successful intraoperative development, taking into account the following philosophy: In robotic myomectomy, if the objective is below the umbilical scar, we can place the robotic lens at the umbilical level. But if the objective is at the umbilical level or above it, then we need an adequate working distance of between 7 and 10 cm, depending on the case to be able to develop our work well and then the lens must be

of removing the number of fibroids and planning the hysterotomy.

and concluded that compared to the laparoscopic and abdominal approaches, robotic surgery is significantly associated with: lower indices of complications,

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**Figure 1.** *Protocol magnetic resonance imaging for fibroids localization.*

Finally the development of the surgery step by step is as follows:


**Figure 2.** *Port placement configuration.*

**Figure 3.** *Infiltration of the myometrium.*

In our country there has been a good acceptance for the use of this platform in cases of myomectomies including the birth at the end of babies without the fear of a major complication such as uterine rupture. Thus showing that robotic myomectomy is an accessible, efficient and flattering pathway for patients with fibroids who want a pregnancy.

We must point out that our group performs robotic myomectomies with only two arms apart from the robot chamber, and we believe that it is essential to maintain a controlled cost in the operative processes without skimping on good results. The vast majority of the aforementioned and currently available studies have performed robotic-assisted laparoscopic myomectomies with four arms, that is, a central port for the camera and three robotic ports plus the necessary accessories, which is usually at least one. More. That gives you certain operative advantages but in most cases few cosmetic advantages and if it is to invade as little as possible

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**Figure 5.** *Myoma enucleation.*

**Figure 4.**

*Incision of the myometrium.*

*Robotic Myomectomy: Until Achieving Reproductive Success, Step by Step*

it would be prudent to use as few ports as possible. This challenges even more any surgical plan, but provides greater esthetics, less invasion with cost containment for the benefit of all, patient, hospital and third-party payers if applicable, which is in

1.A robot must not harm a human being or, because of its inaction, let a human

2.A robot must obey orders given by a human being, except when these orders

3.A robot must protect its own existence, until this protection is not in conflict

the end what is sought, good results with minimal access. Finally we do the following historical reflection:

being suffer harm.

are in opposition to the first law.

with the first or second laws.

*DOI: http://dx.doi.org/10.5772/intechopen.97880*

*Robotic Myomectomy: Until Achieving Reproductive Success, Step by Step DOI: http://dx.doi.org/10.5772/intechopen.97880*

**Figure 4.** *Incision of the myometrium.*

*Latest Developments in Medical Robotics Systems*

In our country there has been a good acceptance for the use of this platform in cases of myomectomies including the birth at the end of babies without the fear of a major complication such as uterine rupture. Thus showing that robotic myomectomy is an accessible, efficient and flattering pathway for patients with fibroids who

We must point out that our group performs robotic myomectomies with only two arms apart from the robot chamber, and we believe that it is essential to maintain a controlled cost in the operative processes without skimping on good results. The vast majority of the aforementioned and currently available studies have performed robotic-assisted laparoscopic myomectomies with four arms, that is, a central port for the camera and three robotic ports plus the necessary accessories, which is usually at least one. More. That gives you certain operative advantages but in most cases few cosmetic advantages and if it is to invade as little as possible

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want a pregnancy.

*Infiltration of the myometrium.*

**Figure 3.**

**Figure 2.**

*Port placement configuration.*

**Figure 5.** *Myoma enucleation.*

it would be prudent to use as few ports as possible. This challenges even more any surgical plan, but provides greater esthetics, less invasion with cost containment for the benefit of all, patient, hospital and third-party payers if applicable, which is in the end what is sought, good results with minimal access.

Finally we do the following historical reflection:


**Figure 6.** *Intact endometrial dome and less use of energy.*

**Figure 7.** *Total myometrium closure.*

The above is an excerpt from Isaac Asimov's futuristic novel: Me, a robot written in 1950 and showing how human beings have always maintained a special interest in the robotic theme [18]. What awaits us in the future? we will know soon.
