BACKGROUND: This study aimed to compare surgical outcomes between two new robotic single-site myomectomy (RSSM)-complementary techniques: coaxial robotic single-site myomectomy (Coaxial-RSSM) and hybrid robotic single-site myomectomy (Hybrid-RSSM).
METHODS: Medical records for 132 women undergoing Coaxial-RSSM and 150 undergoing Hybrid-RSSM, consecutively, were retrospectively reviewed. Patient characteristics and surgical outcomes were assessed and compared after propensity score matching (PSM).
RESULTS: In the outcomes of PSM, the Coaxial-RSSM group showed significantly reduced blood loss (79.71 vs. 163.75 mL, p < 0.001) and reduced hospital duration (4.18 ± 0.62 vs. 4.63 ± 0.90) relative to the Hybrid-RSSM group. Conversely, Hybrid-RSSM allowed for a shorter operative time compared with Coaxial-RSSM (119.19 vs. 156.01 min, p = 0.007). No conversions to conventional laparoscopy or laparotomy or any need for the multi-site robotic approach occurred in either group. Postoperative complications, including ileus, fever, and wound dehiscence, showed no statistically significant differences between the two groups.
CONCLUSIONS: Blood loss was lower with Coaxial-RSSM, and operative time was shorter for Hybrid-RSSM. A follow-up prospective study is warranted for more comprehensive comparison of surgical outcomes between the two techniques.

The article \"Comparison of operative and fertility outcomes of single-incision robotic myomectomy: a retrospective single-center analysis of 286 cases\" by Kim et al. compares the effectiveness of robotic single-port myomectomy against the traditional multiport approach. The study finds similar operating outcomes, complication rates, and pregnancy rates in expert hands for both methods. Our systematic review supports these findings, revealing no significant differences in operative time, blood loss, or complication rates. Recent meta-analysis further emphasizes the benefits of the single-port approach in reducing morcellation time, overall operative duration, and blood loss. Our letter seeks insights on patient selection criteria to minimize conversion rates between surgical approaches and inquiries on learning curve differences. Additionally, we seek cost analysis details for both techniques. We appreciate the authors\' valuable contributions to this field.

OBJECTIVE: To determine the median perioperative blood loss (PBL) during minimally invasive surgical (MIS) myomectomy.
METHODS: Prospective pilot study.
METHODS: Large academic teaching hospital.
METHODS: Thirty-one patients underwent laparoscopic or robotic myomectomy and completed a postoperative complete blood count (CBC) from November 2020 to August 2022. Patients had to have at least one fibroid greater than or equal to 3 cm on preoperative imaging.
METHODS: A CBC was collected preoperatively within 7 days of surgery. Estimated blood loss (EBL) was determined by the surgeon intraoperatively. A repeat CBC was drawn between postoperative days 2 through 4. PBL was calculated using the equation PBL = (patient weight in kg × 65 cc/kg) × (preoperative hematocrit - postoperative hematocrit)/preoperative hematocrit.
RESULTS: Median PBL (536.3 cc [270.0, 909.3]) was greater than median EBL (200.0 cc [75.0, 500.0]). PBL ranged from a net gain of 191.5 cc to net loss of 2362.5 cc. Median size of the largest fibroid on preoperative imaging was 8.8 cm (6.6, 11.5), and median weight of fibroids removed was 321 g (115, 519). About half of patients (51.6%) had one fibroid removed, and 48.4% had 2 or more fibroids removed. Five patients were converted to laparotomy, 4 from robotic approaches. Two patients required a blood transfusion.
CONCLUSIONS: Calculated PBL was greater than intraoperative EBL. This suggests there is continued blood loss post myometrial bed closure. Blood loss should be evaluated both during and after myomectomy, as intraoperative EBL underestimates total PBL.

BACKGROUND: We aimed to evaluate the usefulness of YouTube videos for helping patients become informed about robotic myomectomy.
METHODS: We searched YouTube using \"robotic myomectomy\" and \"Da Vinci myomectomy.\" Videos were sorted by view count, with the 150 most highly viewed videos being selected. From each video, content type, source, view count, video length, time on YouTube, likes, and dislikes were extracted. A scoring system was used to evaluate video quality.
RESULTS: The most prevalent content was recordings of actual surgical procedures of robotic myomectomy, and the most common provider was gynecologic surgeons. Videos directly related to robotic myomectomy were mainly provided by medical groups, had been present on YouTube for a significantly longer time (p = 0.003), and had a higher rate of no responses from viewers (p = 0.014) than videos indirectly related to robotic myomectomy. Videos uploaded by nonmedical groups had more likes, more dislikes, and a higher view ratio (p = 0.029, 0.042, and 0.042, respectively). Scores reflecting video quality did not differ between the two groups. Multiple logistic regression revealed that low-quality videos (less than score 5) were significantly correlated with content indirectly related to robotic myomectomy, poor general quality, fewer views, fewer likes, and no response by viewers.
CONCLUSIONS: Patients who want to get informed about robotic myomectomy on YouTube should exclude low-quality videos according to such parameters as content, views, and response by viewers. In addition, medical groups should provide videos of good quality for instructing patients about this procedure.

Objective: This study aimed to compare the surgical outcomes between robotic multi-site myomectomy (RMSM) and robotic single-site myomectomy (RSSM), using the da Vinci® SP surgical system and perform propensity score matching analysis to ensure inter-group comparability. Methods: This retrospective study included 105 patients who underwent either three-incision RMSM or RSSM using the da Vinci® SP surgical system. We retrospectively reviewed and compared surgical outcomes using 1:1 propensity score matching. Results: After 1:1 propensity score matching, there were no differences in the total operation time and estimated blood loss between the groups. The docking time (p < 0.0001) and duration of hospital stay (p = 0.0001) were significantly shorter in the RSSM group than in the RMSM group. Conclusions: The surgical outcomes of RSSM were comparable to those of RMSM. Moreover, compared to RMSM, RSSM using the da Vinci® SP surgical system has shorter docking and morcellation times, and duration of hospital stay.

Robot-assisted surgery is the next phase in the process of transhumanism. Presently, robotic surgery is used in various benign and malignant gynaecological procedures. Robot-assisted surgery is significantly superior to open surgeries in post-surgical hospital stays; however, the difference is less significant in the case of laparoscopic surgery. Estimated blood loss in robotic surgery may be less. Regarding postoperative time, the results have been inconsistent due to variations in surgeons\' experience. The primary drawbacks of robotic systems are their high installation and maintenance costs and lack of tactile feedback. Though robotic surgery allows easy dissection and fine suturing and has a faster recovery rate, to decide whether it should become the mainstream of gynaecological procedures, more randomized controlled trials are needed.

Uterine myomas are benign tumours frequently seen in women of reproductive age. Myomectomy remains a viable option for treating this condition in women who wish to preserve their uterus. We undertook this study to compare the peri-operative surgical outcomes of Robotic myomectomy (RM) with laparoscopic myomectomy (LM) in Indian patients of uterine myomas after the initial learning curve of RM was achieved. A retrospective chart review was performed for the patients who underwent RM or LM for the treatment of uterine myomas. A total of 177 patients, 116 in the RM group and 61 in the LM group, were included in the study. The mean age in the RM and LM group was 34.31 ± 5.40 years and 33.54 ± 4.96 years, respectively (p = 0.355). The mean total operative time was marginally more in RM group (127.37 ± 110.67 vs. 120.66 ± 44.27, p = 0.650) but the difference was not statistically significant. Patients in the RM group had significantly less blood loss (115.43 ± 79.43 vs. 340.98 ± 453.9 ml, p = < 0.0001), hospital stay (1.28 ± 0.49 vs. 1.92 ± 1.05 days, p = < 0.0001), requirement of blood transfusion (93.97 vs. 81.97%, p = 0.031) and requirement of intravenous (IV) analgesia (41.38 vs. 34.43%, p = 0.019) as compared to the patients in the LM group. The Robotic myomectomy significantly reduces blood loss, the duration of hospital stay, and requirement of blood transfusions and IV analgesia as compared to the laparoscopic myomectomy.

To identify factors affecting blood loss and operation time (OT) during robotic myomectomy (RM), we reviewed a total of 448 patients who underwent RM at Seoul Asan Hospital between 1 January 2019, and 28 February 2021, at Seoul Asan Hospital. To avoid variations in surgical proficiency, only 242 patients managed by two surgeons who each performed >80 RM procedures during the study period were included in this study. All cases of RM were performed with a reduced port technique. We obtained the following data from each patient\'s medical chart: age, gravidity, parity, body mass index, and history of previous abdominal surgery including cesarean section. We also collected information on the maximal diameter and type of myomas, number and weight of removed myomas, concomitant surgery, total OT from skin incision to closure, estimated blood loss (EBL), and blood transfusion. Data on preoperative use of gonadotropin-releasing hormone agonists (GnRHas) and perioperative use of hemostatic agents (tranexamic acid or vasopressin) were also collected. Data on the length of hospital stay, postoperative fever within 48 h, and any complications related to RM were also obtained. The primary endpoint in this study was the identification of factors affecting EBL and the secondary endpoint was the identification of factors affecting the total OT during multiport RM. Univariate and multivariate analyses were used to identify the factors affecting EBL and OT during multiport RM. The medians of the maximal diameter and weight of the removed myomas were 9.00 (interquartile range [IQR], 7.00 to 10.00) cm and 249.75 (IQR, 142.88 to 401.00) g, respectively. The median number of myomas was two (IQR, one to four), ranging from 1 to 34. Of the cases, 155 had low EBL and 87 had high EBL. Most myomas were of the intramural type (n = 179). The odds of EBL > 320 mL increased by 251% (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.16-5.42) for five to nine myomas and by 647% (OR, 6.47; 95% CI, 1.87-22.33) for ≥10 myomas. The odds of subserosal-type myomas decreased by 67% compared with intramural-type myomas (OR, 0.33; 95% CI, 0.14-0.80). History of abdominal surgery other than cesarean section was positively correlated with EBL. The weight of the removed myomas and a history of previous cesarean section were not correlated with the EBL. Conclusion: The number of myomas (5-9 and ≥10), maximal myoma diameter, and history of abdominal surgery other than cesarean section affect the EBL in RM.

The robotic-assisted laparoscopic surgical approach has improved complex gynecologic surgeries. It has the advantages of excellent visualization through the high-resolution 3-dimensional view, a wrist-like motion of the robotic arms and improved ergonomics. Similar to conventional laparoscopic surgeries, it is associated with a decrease in long-term surgical morbidity, early recovery and return to work, and improved esthetics. We discuss preoperative planning, surgical techniques, and some of the latest clinical results of robotic-assisted laparoscopic gynecologic surgery.

BACKGROUND: Robotic surgery carries with it the potential to transform laparoscopic surgery by providing, for the 1st time, instruments with distal ends that mimic the intricate movements of the human hand while at the same time providing the surgeon with a high-definition, three-dimensional view of the operative field.
OBJECTIVE: To describe the clinical application of robotic surgery in benign gynecological conditions, as well as the components of the Da Vinci Si robotic system, analyzing the advantages and disadvantages of this type of surgical approach that it provides to the patient and in turn to the surgeon.
METHODS: Review of the literature in PubMed and UpToDate where the keywords of our review were searched. Inclusion criteria: Articles of cases or series containing the sections of the application of robotic surgery in gynecology and clinical results.
RESULTS: We found 50 scientific articles that included in their titles the key words of our review. 22 articles were discarded, 14 because they were inaccessible, 3 because they were published in bulletins without an impact factor and 5 because no information was obtained about the researcher\'s results, their volume, visibility and structure. A total of 28 articles were chosen for this review.
CONCLUSIONS: Robotic surgery has evolved to be a separate field, with enormous potential for future development. The results show until now that this technology is applicable and capable of offering an adequate treatment to selected patients.
BACKGROUND: La cirugía robótica conlleva el potencial de transformar la cirugía laparoscópica al proporcionar, por primera vez, instrumentos con extremos distales que imitan los intrincados movimientos de la mano humana, mientras que al mismo tiempo proporciona al cirujano una alta definición con visión tridimensional del campo operatorio.
OBJECTIVE: Describir la aplicación clínica de la cirugía robótica en padecimientos ginecológicos benignos, así como los componentes del sistema robótico Da Vinci Si, analizando las ventajas y desventajas que este tipo de abordaje quirúrgico brinda a la paciente y a su vez al cirujano.
UNASSIGNED: Revisión de la bibliografía en PubMed y UpToDate buscando las palabras clave de nuestra revisión. Criterios de inclusión: artículos de casos o series que contuvieran los apartados de la aplicación de la cirugía robótica en ginecología y resultados clínicos.
RESULTS: Se encontraron 50 artículos científicos que incluían en sus títulos las palabras clave de nuestra revisión. Se descartaron 22 artículos, 14 por ser inaccesibles, tres debido a que estaban publicados en boletines sin factor de impacto y cinco porque no se obtuvo información sobre los resultados del investigador, su volumen, visibilidad y estructura. Se escogieron para esta revisión 28 artículos.
CONCLUSIONS: La cirugía robótica ha evolucionado hasta ser un campo aparte, con un enorme potencial para su futuro desarrollo. Los resultados muestran que esta tecnología es aplicable y capaz de ofrecer un adecuado tratamiento a pacientes seleccionadas.