Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus. Some subserosal or submucosal fibroids may be pedunculated — hanging from a stalk inside or outside the uterus.
Robotic myomectomy, a type of laparoscopic myomectomy, is a minimally invasive way for surgeons to remove uterine fibroids. Compared to open abdominal surgery, with robotic myomectomy you may experience less blood loss, have fewer complications, have a shorter hospital stay and return to normal activities more quickly.
Robotic surgery may take longer and be more costly than traditional laparoscopy, but otherwise results are likely to be similar.
Why it's done
Your doctor may recommend robotic myomectomy if you have:
- Certain types of fibroids. Surgeons may use laparoscopic myomectomy, including robotic myomectomy, to remove fibroids that are within the uterine wall (intramural) or that project to the outside of the uterus (subserosal).
- Smaller, or a limited number of, uterine fibroids. Because the incisions used in robotic myomectomy are so small, this procedure works best with smaller uterine fibroids, which are easier to extract.
- Uterine fibroids that cause chronic pain or heavy bleeding. Robotic myomectomy may be a safe, effective way to get relief.
Robotic myomectomy has a low complication rate. Still, risks may include:
- Excessive blood loss. During robotic myomectomy, surgeons take extra steps to avoid excessive bleeding, including blocking flow from the uterine arteries and injecting medications around fibroids to cause blood vessels to clamp down.
- Infection. Though the risk is small, the robotic myomectomy procedure presents the risk of infection.
How you prepare
Food and medications
You'll need to fast — stop eating or drinking anything — in the hours before your surgery. Follow your doctor's recommendation on the specific number of hours.
If you're on medications, ask your doctor if you should change your usual medication routine in the days before surgery. Tell your doctor about any over-the-counter medications, vitamins or other dietary supplements that you're taking.
In most cases, robotic myomectomy is done as an outpatient procedure or requires one overnight hospital stay. Your facility may require that you have someone accompany you on the day of surgery. Make sure you have someone lined up to help with transportation and to be supportive.
What you can expect
Before the procedure
Robotic myomectomies are performed under general anesthesia, which means you're asleep during the surgery. Ask your doctor about pain medication and how it will likely be given.
During the procedure
In robotic myomectomy, your surgeon accesses and removes fibroids through several small abdominal incisions. Sitting at a separate computer console, the surgeon controls a camera and movement of instruments attached to robotic arms. Some surgeons now perform single-port (one incision) robotic myomectomies.
Using smaller incisions means you may have less pain, lose less blood and return to normal activities more quickly than with other methods of myomectomy.
After the procedure
After a robotic myomectomy, you may stay in the hospital for one night. Your treatment team will observe your condition while you're in the hospital, control your pain and make sure you're comfortable. You can expect some vaginal bleeding for several days after the procedure.
During your recovery, which typically lasts about two to four weeks, you'll need to avoid strenuous exercise and heavy lifting. Your doctor may encourage walking or other light exercise. You may return to work as soon as you feel able. You may resume sex as soon as you feel comfortable doing so.
Outcomes from robotic myomectomy may include:
- Symptom relief. After robotic myomectomy surgery, most women experience relief of bothersome signs and symptoms, such as excessive menstrual bleeding and pelvic pain and pressure.
- Fertility improvement. Some studies suggest women have good pregnancy outcomes within about a year of surgery. After a robotic myomectomy, wait three to six months — or longer — before attempting to become pregnant to allow the uterus enough healing time.