Ultrasound-guided robotic myomectomy using a drop-in probe.

Abstract

Robot-assisted myomectomy offers the advantages of minimally invasive surgery but lacks tactile feedback, making identification of intramural fibroids dependent on visual assessment. This limitation may be particularly relevant in fertility-preserving surgery and in patients with multiple myomas. Although laparoscopic intraoperative ultrasound has been used to facilitate fibroid detection during minimally invasive myomectomy, the published experience of intraoperative ultrasound used during robot-assisted myomectomy remains limited. We present a technique for ultrasound-guided robot-assisted myomectomy using a robotic drop-in ultrasound probe. After enucleation of visually identified fibroids, the probe is applied directly to the uterine surface and systematically scanned across the myometrium while ultrasound images are displayed simultaneously with the operative field on the robotic console. This allows real-time correlation of imaging findings with surgical anatomy, facilitates identification of occult intramural fibroids, and supports ultrasound-guided enucleation when indicated. Figures 1 and 2 demonstrate the probe and its intraoperative application, and the accompanying video illustrates probe handling, systematic uterine scanning, and ultrasound-guided fibroid enucleation.