Robotic surgery is a surgical method that combines the best aspects of laparoscopic surgery and open surgery. Performing robotic surgery in the removal of fibroids that are too large to be removed by laparoscopy prevents factors such as larger incision, higher blood loss and damage to the surrounding tissue in open surgery. At the same time, greater mobility and vision capabilities allow to prevent complications in laparoscopic surgery.

The most important risks in myoma surgeries are the rupture of the uterus and the problems that may occur in future pregnancies. With Robotic Myomectomy, these possibilities are reduced to almost zero.

After placing the robotic instruments on the patient with 2 10 mm and 2 8 mm incisions, an incision is made in the area of the fibroids. After the fibroids are separated from the uterine wall, the uterine wall is repaired in 2 to 3 layers and the removed fibroids are broken up and removed through the small hole.

The biggest advantage of robotic myomectomy is that it is the safest method for future pregnancies. Since the incisions are small, pain and blood loss are less. Since the incisions are very small, scarring is almost negligible. It provides the possibility of discharge on the same day and a faster return to daily life.

In this method, a tiny incision is made near the navel, and the abdomen is inflated with carbon dioxide gas. An instrument called a laparoscope is inserted into the pelvic cavity and images of the uterus, ovaries and neighboring pelvic organs are taken. Then the operation is done through other small incisions made in the abdominal wall. The fibroid is removed through extra-small incisions in the uterine wall or a small incision in the vagina. (colpotomy)

Laparoscopy uses smaller incisions than laparotomy, thus shortening the post-operative recovery period. Some surgeons have specific rules for determining when laparoscopy can be performed regarding the size and number of fibroids. However, there is no consensus on this. A surgeon may use this technique only for fibroids outside the uterus and easy to reach. An experienced surgeon can remove even very large fibroids by laparoscopy.

Laparoscopic myomectomy usually does not require hospitalization, and the recovery period is between a few days and 2 weeks. It has very important advantages over open surgery.

Hysteroscopic myomectomy may be recommended to treat submucosal fibroids, i.e. fibroids that bulge and protrude in the uterine cavity.

General or spinal anesthesia is used in hysteroscopic myomectomy. A small, lighted instrument called a resectoscope is inserted through the vagina, which can cut through the tissues. Attached to the instrument is a tube that releases a clear fluid and expands the uterine cavity so that it is possible to examine the uterine walls.

Subsequently, the fibroid is dissected with the aid of a resectoscope until it aligns with the surface of the uterine cavity. The removed tissue is cleaned by washing with the liquid that expands the uterus.

In hysteroscopic myomectomy, hospitalization is usually not required, the recovery period is less than a week.

Abdominal myomectomy is performed under general anesthesia. The uterine cavity is reached through one or two incisions:

- Vertical incision: It is an incision starting from the middle of the abdomen and extending to the pubic bone below the navel. The vertical incision gives the surgeon greater access to the uterus and reduces bleeding. Some surgeons recommend using a vertical incision if the uterus appears to be enlarged, as if it were carrying a 16-week pregnancy. This incision is also useful if the fibroid is a connective tissue between the uterus and pelvic wall.

- Horizontal incision: It is an incision above the pubic bone. Because it follows natural skin lines, a thinner wound causes less pain. However, there is less access to the pelvis; this is also an important issue if the uterus is large or disrupted.

During the operation, the surgeon examines the uterus visually and fibroids with the help of hand. He makes an incision in the uterus up to the level of the fibroid, grasps the fibroid with instruments and pulls it away from the normal uterine tissues. It then repairs the uterus.

After the operation, medical team members monitor your condition in the patient's room. Once the effects of the anesthesia wear off, you will go to your room for observation.

He can give morphine and similar drugs to keep the pain under control. Many hospitals now have systems that are under your control, where you press a button and send a sedative to your vein when you have pain.

Usually the next day you switch to oral medications instead of intravenous drugs. You can have the IV inserted until you can get fluids and you can't start consuming solid foods right away. Medical team members encourage you to start walking as soon as possible because this reduces the risk of post-operative complications.

When you are discharged from the hospital, your doctor will prescribe painkillers, inform you about how to take care of the incision site, diet list and activities. You should avoid activities such as driving, heavy lifting, climbing stairs. You should abstain from sexual intercourse and tampon use for up to 6 weeks. Again, it's natural to have vaginal discharge during this time.

Abdominal myomectomy requires a hospital stay of 2-3 days. Recovery takes 4 to 6 weeks.

Myomectomy has a very low complication rate. However, the surgeon performing the operation is very important. The risks of myomectomy are as follows:

- Excessive blood loss: There is a network of blood vessels in the uterus and fibroids stimulate the growth of new vessels to provide blood flow to them. In other words, during myomectomy, extra precautions should be taken against the risk of excessive bleeding. These measures include blocking the flow from the uterine veins and injecting drugs around the fibroids to compress the blood vessels.

- Scar Tissue: Incisions made to the uterus to remove fibroids may cause adhesions (adhesions that can develop after the operation). Adhesions can block the development of the fertilized egg in the uterus, but this condition rarely develops. Outside the uterus, they can interfere with nearby structures, resulting in blocked tubes or intestinal knotting.

- Development of New Myomas: Myomectomy does not prevent the development of new myomas. Tiny tumors that are not seen during the operation may enlarge and cause symptoms. It is possible for new fibroids to develop as well. Women with only one fibroid are less likely to develop new fibroids than those with multiple fibroids. If fibroids recur, repeat myomectomy, hysterectomy, or other procedures may be done.

- Birth Complications: Having had a myomectomy may cause some complications in childbirth. If your surgeon had to make a deep incision in the uterine wall during the operation, the delivering doctor may have to perform a cesarean section to prevent cracking of the uterus during delivery.

- Impossibility to Rearrange the Structure of the Womb: Your surgeon may have to cut the muscle wall, leaving a gap in order to remove the fibroids. It will require multiple stitches to close it. Rarely, the uterus may need to be removed if the bleeding is severe or has failed to realign the uterus.

To minimize the risks of myomectomy, your doctor may recommend:

- Iron Supplements and Multivitamins: If you have iron deficiency due to the severity of your menstrual bleeding, your doctor may recommend that you take iron supplements before surgery.

- Hormone Therapy: Another strategy for correcting anemia is hormone therapy before surgery. Your doctor may recommend that you use Gn-RH agonists, birth control pills, or other hormone treatments to stop or reduce menstrual bleeding. When given as therapy, Gn-RH agonists block the production of estrogen and progesterone, stopping menstruation and thus allowing you to store hemoglobin and iron.

- Treatment for Shrinking Myomas: Some hormonal treatments, such as Gn-RH therapy, cause fibroids and the uterus to shrink, allowing the surgeon to use a minimally invasive surgical approach (a smaller horizontal incision instead of a vertical incision, or laparoscopy instead of open surgery). Gn-RH agonists produce menopausal symptoms in most women. (such as hot flashes, night sweats and vaginal dryness) However, these ailments end with the end of the drug use.