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Robot-Assisted Laparoscopic Myomectomy versus Abdominal Myomectomy for Large Myomas Sized over 10 cm or Weighing 250 g

Yonsei Medical Journal 2020년 61권 12호 p.1054 ~ 1059
이사라, 이은실, 이영재, 이신화, 박정열, 김대연, 김성훈, 김용만, 서대식, 김영탁,
소속 상세정보
이사라 ( Lee Sa-Ra ) - University of Ulsan College of Medicine Asan Medical Center Department of Obstetrics and Gynecology
이은실 ( Lee Eun-Sil ) - Soonchunhyang University College of Medicine Soonchunhyang University Seoul Hospital Department of Obstetrics and Gynecology
이영재 ( Lee Young-Jae ) - University of Ulsan College of Medicine Asan Medical Center Department of Obstetrics and Gynecology
이신화 ( Lee Shin-Wha ) - University of Ulsan College of Medicine Asan Medical Center Department of Obstetrics and Gynecology
박정열 ( Park Jeong-Yeol ) - University of Ulsan College of Medicine Asan Medical Center Department of Obstetrics and Gynecology
김대연 ( Kim Dae-Yeon ) - University of Ulsan College of Medicine Asan Medical Center Department of Obstetrics and Gynecology
김성훈 ( Kim Sung-Hoon ) - University of Ulsan College of Medicine Asan Medical Center Department of Obstetrics and Gynecology
김용만 ( Kim Yong-Man ) - University of Ulsan College of Medicine Asan Medical Center Department of Obstetrics and Gynecology
서대식 ( Suh Dae-Shik ) - University of Ulsan College of Medicine Asan Medical Center Department of Obstetrics and Gynecology
김영탁 ( Kim Young-Tak ) - University of Ulsan College of Medicine Asan Medical Center Department of Obstetrics and Gynecology

Abstract


Purpose: Here, we compared the operative and perioperative outcomes between robot-assisted laparoscopic myomectomy (RALM) and abdominal myomectomy (AM) in patients with large (>10 cm) or heavy myomas (>250 g).

Materials and Methods: We included 278 patients who underwent multi-port RALM (n=126) or AM (n=151) for large or heavy myomas in a tertiary care hospital between April 2019 and June 2020. The t-test, chi-square, Bonferroni's test, and multiple linear regression were used.

Results: No differences were observed in age, body mass index, parity, or history of pelvic surgery between the two groups. Myoma diameters were not different (10.8±2.52 cm vs. 11.2±3.0 cm, p=0.233), but myomas were lighter in the RALM group than in the AM group (444.6±283.14 g vs. 604.68±368.35 g, respectively, p=0.001). The RALM group had a higher proportion of subserosal myomas, fewer myomas, fewer large myomas over >3 cm, lighter myomas, and longer total operating time. However, the RALM group also had shorter hospital stay and fewer short-term complications. Estimated blood loss (EBL) was not different between the two groups. The number of removed myomas was the most significant factor (coefficient=10.89, p<0.0001) affecting the EBL.

Conclusion: RALM is a feasible myomectomy technique even for large or heavy myomas. RALM patients tend to have shorter hospital stays and fewer postoperative fevers within 48 hours. However, RALM has longer total operating time.

키워드

Fertility; open abdomen techniques; robotic surgical procedures; uterine myomectomy

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