How to minimize endometrium damage during robotic myomectomy?

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This video review focuses on strategies to minimize endometrial damage during robot-assisted myomectomy, specifically in cases involving submucosal fibroids. Submucosal fibroids, accounting for 5–10% of all fibroids, are linked to improved fertility outcomes when surgically removed. Depending on the fibroid’s location and size, treatment options include hysteroscopic surgery, laparotomy, or minimally invasive techniques, with the American Association of Gynecologic Laparoscopists (AAGL) recommending minimally invasive surgery whenever possible.

Key principles in reducing endometrial injury include delicate dissection of the endometrial layer from the fibroid, careful assessment of uterine manipulator ballooning, and, when feasible, the use of intraabdominal ultrasound. In the event of endometrial damage, thorough repair using absorbable fine suture materials is essential, with considerations given to tensile strength and handling characteristics of different suture types.

The video presents three clinical cases illustrating various approaches to myomectomy, repair techniques, and postoperative outcomes. These include meticulous suturing of endometrial defects, employing techniques such as cold cuts and continuous running sutures. Each case emphasizes the importance of layer-by-layer closure to preserve endometrial integrity and optimize fertility outcomes.

In addition to surgical repair, the use of adhesion barriers and hormone therapy, particularly estrogen for 2–3 cycles, can aid in endometrial regeneration and healing. The video also discusses intrauterine catheterization as a potential adjunct to prevent adhesions, with options including intra-uterine devices, Foley catheters, or intrauterine balloons.

In conclusion, the video highlights the importance of careful surgical technique in minimizing endometrial damage during myomectomy, as well as the role of adjunctive therapies to support tissue healing and improve fertility outcomes.

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