{"paper_id":"019d7d39-f066-45c4-abae-04f681ae1906","body_text":"Abstract\nWe describe a novel surgical technique combining the use of a robotic surgical platform with a flexible CO2 laser in gynecologic surgery at a university-hospital-based reproductive medicine practice. Thirteen women with symptomatic uterine fibroids and/or adenomyosis, desiring uterine conservation, underwent robot-assisted laparoscopic myomectomy or focal adenomyomectomy with CO2 laser energy using a novel flexible delivery fiber (BeamPath GYN-L fiber, OmniGuide, Cambridge, MA, USA). On average, four myomas or areas of adenomyosis were removed with an average total specimen weight of 95 g. The average operating time was 169 min and the average estimated blood loss was 25 mL. No perioperative complications were observed. Preliminary experience with robot-assisted minimally invasive gynecologic surgery utilizing a novel flexible CO2 laser fiber has comparable operative outcomes to those reported for conventional laparoscopic energy sources, and this technique appears safe. The minimal lateral thermal spread of photonic energy, combined with the enhanced precision allowed by a computer-based surgical platform, appears ideal for reproductive surgical applications.\nSimilar content being viewed by others\nReferences\nHendriks ML, van der Valk P, Lambalk CB, Broeckaert MA, Homburg R, Hompes PG (2010) Extensive tissue damage of bovine ovaries after bipolar ovarian drilling compared to monopolar electrocoagulation or carbon dioxide laser. Fertil Steril 93(3):969–975. doi:10.1016/j.fertnstert.2008.10.046\nSoong YK, Chang FH, Chou HH, Chang MY, Lee CL, Lai YM, Chang SY (1997) Life table analysis of pregnancy rates in women with moderate or severe endometriosis comparing danazol therapy after carbon dioxide laser laparoscopy plus electrocoagulation or laparotomy plus electrocoagulation versus danazol therapy only. J Am Assoc Gynecol Laparosc 4(2):225–230\nFambrini M, Penna C, Pieralli A, Fallani MG, Andersson KL, Lozza V, Scarselli G, Marchionni M (2008) Carbon-dioxide laser vaporization of the Bartholin gland cyst: a retrospective analysis on 200 cases. J Minim Invasive Gynecol 15(3):327–331. doi:10.1016/j.jmig.2008.02.005\nPenna C, Fallani MG, Fambrini M, Zipoli E, Marchionni M (2002) CO2 laser surgery for vulvar intraepithelial neoplasia. Excisional, destructive and combined techniques. J Reprod Med 47(11):913–918\nDonnez J, Nisolle M (1997) Endoscopic laser treatment of uterine malformations. Hum Reprod 12(7):1381–1387\nMcLaughlin DS (1985) Current uses of the laser for fertility-promoting procedures. Lasers Surg Med 5(6):539–561\nBaggish MS (1983) Status of the carbon dioxide laser for infertility surgery. Fertil Steril 40(4):442–445\nShurgalin M, Anastassiou C (2008) A new modality for minimally invasive CO2 laser surgery: flexible hollow-core photonic bandgap fibers. Biomed Instrum Technol 42(4):318–325. doi:10.2345/0899-8205(2008)42[318:ANMFMI]2.0.CO;2\nKillory BD, Chang SW, Wait SD, Spetzler RF (2010) Use of flexible hollow-core CO2 laser in microsurgical resection of CNS lesions: early surgical experience. Neurosurgery 66(6):1187–1192. doi:10.1227/01.NEU.0000369195.17553.F3\nDevaiah AK, Shapshay SM, Desai U, Shapira G, Weisberg O, Torres DS, Wang Z (2005) Surgical utility of a new carbon dioxide laser fiber: functional and histological study. Laryngoscope 115(8):1463–1468. doi:10.1097/01.mlg.0000171021.73635.3b\nCheetham PJ, Truesdale MD, Lee DJ, Landman JM, Badani KK (2010) Use of a flexible carbon dioxide laser fiber for precise dissection of the neurovascular bundle during robot-assisted laparoscopic prostatectomy. J Endourol 24(7):1091–1096. doi:10.1089/end.2010.0132\nSutton PA, Awad S, Perkins AC, Lobo DN (2010) Comparison of lateral thermal spread using monopolar and bipolar diathermy, the Harmonic Scalpel and the Ligasure. Br J Surg 97(3):428–433. doi:10.1002/bjs.6901\nGargiulo AR (2011) Fertility preservation and the role of robotics. Clin Obstet Gynecol 54(3):431–448. doi:10.1097/GRF.0b013e31822b3b80\nBarakat EE, Bedaiwy MA, Zimberg S, Nutter B, Nosseir M, Falcone T (2011) Robotic-assisted, laparoscopic, and abdominal myomectomy: a comparison of surgical outcomes. Obstet Gynecol 117(2 Pt 1):256–265. doi:10.1097/AOG.0b013e318207854f\nSeracchioli R, Rossi S, Govoni F, Rossi E, Venturoli S, Bulletti C, Flamigni C (2000) Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod 15(12):2663–2668\nMais V, Ajossa S, Guerriero S, Mascia M, Solla E, Melis GB (1996) Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol 174(2):654–658\nPalomba S, Zupi E, Falbo A, Russo T, Marconi D, Tolino A, Manguso F, Mattei A, Zullo F (2007) A multicenter randomized, controlled study comparing laparoscopic versus minilaparotomic myomectomy: reproductive outcomes. Fertil Steril 88(4):933–941. doi:10.1016/j.fertnstert.2006.12.047\nLiu G, Zolis L, Kung R, Melchior M, Singh S, Cook EF (2010) The laparoscopic myomectomy: a survey of Canadian gynaecologists. J Obstet Gynaecol Can 32(2):139–148\nAdvincula AP, Song A, Burke W, Reynolds RK (2004) Preliminary experience with robot-assisted laparoscopic myomectomy. J Am Assoc Gynecol Laparosc 11(4):511–518\nBedient CE, Magrina JF, Noble BN, Kho RM (2009) Comparison of robotic and laparoscopic myomectomy. Am J Obstet Gynecol 201(6):566.e1–566.e5. doi:10.1016/j.ajog.2009.05.049\nNezhat C, Lavie O, Hsu S, Watson J, Barnett O, Lemyre M (2009) Robotic-assisted laparoscopic myomectomy compared with standard laparoscopic myomectomy–a retrospective matched control study. Fertil Steril 91(2):556–559. doi:10.1016/j.fertnstert.2007.11.092\nStarks GC (1988) CO2 laser myomectomy in an infertile population. J Reprod Med 33(2):184–186\nSeracchioli R, Manuzzi L, Vianello F, Gualerzi B, Savelli L, Paradisi R, Venturoli S (2006) Obstetric and delivery outcome of pregnancies achieved after laparoscopic myomectomy. Fertil Steril 86(1):159–165. doi:10.1016/j.fertnstert.2005.11.075\nSizzi O, Rossetti A, Malzoni M, Minelli L, La Grotta F, Soranna L, Panunzi S, Spagnolo R, Imperato F, Landi S, Fiaccamento A, Stola E (2007) Italian multicenter study on complications of laparoscopic myomectomy. J Minim Invasive Gynecol 14(4):453–462. doi:10.1016/j.jmig.2007.01.013\nDubuisson JB, Fauconnier A, Deffarges JV, Norgaard C, Kreiker G, Chapron C (2000) Pregnancy outcome and deliveries following laparoscopic myomectomy. Hum Reprod 15(4):869–873\nParker WH, Einarsson J, Istre O, Dubuisson JB (2010) Risk factors for uterine rupture after laparoscopic myomectomy. J Minim Invasive Gynecol 17(5):551–554. doi:10.1016/j.jmig.2010.04.015\nDarwish AM, Nasr AM, El-Nashar DA (2005) Evaluation of postmyomectomy uterine scar. J Clin Ultrasound 33(4):181–186. doi:10.1002/jcu.20106\nChang WC, Chang DY, Huang SC, Shih JC, Hsu WC, Chen SY, Sheu BC (2009) Use of three-dimensional ultrasonography in the evaluation of uterine perfusion and healing after laparoscopic myomectomy. Fertil Steril 92(3):1110–1115. doi:10.1016/j.fertnstert.2008.07.1771\nRyan RW, Wolf T, Spetzler RF, Coons SW, Fink Y, Preul MC (2010) Application of a flexible CO(2) laser fiber for neurosurgery: laser-tissue interactions. J Neurosurg 112(2):434–443. doi:10.3171/2009.7.JNS09356\nTulikangas PK, Smith T, Falcone T, Boparai N, Walters MD (2001) Gross and histologic characteristics of laparoscopic injuries with four different energy sources. Fertil Steril 75(4):806–810. doi:10.1016/S0015-0282(00)01785-4\nAdvincula AP, Xu X, Goudeau S, Ransom SB (2007) Robot-assisted laparoscopic myomectomy versus abdominal myomectomy: a comparison of short-term surgical outcomes and immediate costs. J Minim Invasive Gynecol 14(6):698–705. doi:10.1016/j.jmig.2007.06.008\nConflict of interest\nNone.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nRights and permissions\nAbout this article\nCite this article\nBarton, S.E., Gargiulo, A.R. Robot-assisted laparoscopic myomectomy and adenomyomectomy with a flexible CO2 laser device. J Robotic Surg 7, 157–162 (2013). https://doi.org/10.1007/s11701-012-0360-5\nReceived:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s11701-012-0360-5","source_license":"CC0","license_restricted":false}