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Comparison of Pregnancy Prognosis by Surgical Management for Adnexal Mass in Pregnancy
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Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S103eS157
due to underlying pathology. Excluded were cases that had to be repaired via laparotomy. Setting: Tertiary referal medical center. Patients: 10345 laparoscopic gynecological cases were reviewed. 12 cases (median age of 45.5) of ureter transections were diagnosed (lower 1/3) and repaired laparoscopically. 83.3% had previous surgeries, pelvic adhesions or a large pelvi-abdominal mass. Intervention: 1 case had undergone a segmental resection and ureteroureterostomy for infiltrative endometriosis. Of the remaining 11 iatrogenic ureteral transections, 10 were repaired via uretero-ureterostomy while 1 had undergone an ureteroneocystostomy.
The BMI mean was 26.51 kg/m3. Tumor size has a significant positive impact on surgery time (p 5 0.0205) and number of tumors had a significant positive impact on console time (p 5 0.0246). Tumor size, number of leiomyomata, console time, and non console time, are statistically significant positive impact on the blood loss with p value of 0.0031, 0.0181, 0.0001, and 0.0002 respectively. Conclusion: da Vinci robotic equipment has made the laparoscopic myomectomy procedure more precise, with less blood loss and technically easier for the surgeon. It provides the patient with a shorter hospital stay, less post operative pain, quicker return to normal activities and less scarring.
451 Ipsilateral Ovarian Pregnancy after Vaginal Salpingectomy: A Case Report Hong S-Y, Kim D-W, Shin J-W, Park W-I, Seo Y-S. Obstetrics and Gynecology, Eulji Hospital, School of Medicine Eulji University, Seoul, Republic of Korea
1 injury was recognized on the 2nd post-operative day, but intra-operative recognition was attained in 11 cases (91.7%). Measurements and Main Results: The median duration of DJ stenting was 73 days. 3 developed strictures (between 42 e 79 days post operation) treated with restenting, but 1 had to undergo an ureteroneocystostomy for ureter disruption. 1 developed leakage of the anastomotic site but recovered with a change of DJ stent. All the patients were well and asymptomatic at the conclusion of this study period. Conclusion: Early recognition and treatment of ureteral injuries are important to prevent morbidity. Laparoscopic uretero-ureterostomy should be attempted in transections of lower 1/3 ureter where technical expertise is available.
Study Objective: To report a rare case of ipsilateral ovarian pregnancy, recurrent type after vaginal salpingectomy for tubal pregnancy, which was successfully treated laparoscopic operation. Design: Case report. Setting: University Hospital, Seoul. Patients: A 21-year-old women who resented at 11 þ 5 wwks of amenorrhea with acute abdominal pain and vaginal bleeding for 2 days. Past medical history included vaginal salpingectomy for right ampullary pregnancy 2 years ago at other Unversity hospital in Seoul, Korea. Intervention: On admission transvaginal ultrasonogam showed normal uterine shape without any evidence of IUP, and right adnexal mass(6X5.5X5.8 cm) which was mainly soli mass with a central hypoechoic portion. The pregnancy test was positive. Initial Impressions were 1) ectopic pregnancy with right ovarian mass, or 2) ovaria pregnancy. Measurements and Main Results: Laparoscopic operation was performed. Intraopratively there as a mandarin orange sized ovary, which was bluish discoloration and cogestion on the surface. Right oophorectomy was performed. Histopathologic examination confirmed the diagnosis of the ovarian regnancy. The postoprative course was uneventful. Conclusion: The case of the ipsilateral ovarin pregnancy after vagianl salingectomy for tubal pregnancy, which was successfully treated with laparoscopic operation, is presented.
450 da Vinci Robotic Laparoscopic Myomectomy Hanafi MM. Gynecology, Saint Joseph’s Hospital of Atlanta, Atlanta, GA Study Objective: To report patients who underwent Robotic laparoscopic myomectomy using the da Vinci robotic system and the factors affecting the total operating time, console time and total blood loss. Design: Retrospective study of a consecutive case series. Setting: Tertiary care facility. Patients: A total of seventy patients with symptomatic leiomyomata. Intervention: Robotic Myomectomy was administered. Measurements and Main Results: Between February 2007 and January 2009, 70 patients (23-57 years) underwent robotic laparoscopic Myomectomy. Out of the 70 patients, 51 patients information was fully obtained. The patient’s data included: total operating time(minutes), console time(minutes),Non console time, estimated blood loss(ml), length of hospital stay(days), number of leiomyomata, tumors size(mm), age (years) and body mass index(kg/m3). Statistical analysis was performed using SAS 9.1 software. A pevalue of less than 0.05 was considered statistically significant. The operating time mean was 204.05 minutes. Console time mean was 99.45 minutes. Non Console time mean was 104.6 min. Blood loss mean was 104.60 ml. Average number of leiomyomata was 3 .Tumor size mean was 43.16. Average length of the hospital stay was 1day. The age mean at the time of surgery was 39 years.
452 Comparison of Pregnancy Prognosis by Surgical Management for Adnexal Mass in Pregnancy Jeung IC. OB&GYN, Daejeon St. Mary’s Hospital, Joong-gu, Daejeon, Republic of Korea Study Objective: To compare pregnancy prognosis by surgical management methods for adnexal mass in pregnancy, we evaluated laparoscopic surgery and laparotomy. Design: Between January 2000 and April 2008, St. Mary’s hospital, Kangnam St. Mary’s hospital, and Daejeon St. Mary’s hospital were included. We performed a systemic retrospective chart review of patient who received by exploratory laparotomy or laparoscopy. Setting: The following factors were assessed: preoperative diagnosis, gestational age at the time of surgery, operative time, hospital stay, pathology, gestational age at delivery, complication and pregnancy outcome in both groups. Student’s t-test and Fisher’s exact test were used for statistical analysis. P-vlaue below 0.05 was considered statistically significant. Patients: 62 patients diagnosed with adnexal mass in pregnancy. Intervention: N/A
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S103eS157 Measurements and Main Results: Laparoscopy 23 cases and exploratory laparotomy 39 cases underwent surgery during the study period. Lower abdominal pain due to cystic mass (50.0%) was the first operative indication and cystic torsion (30.6%) was followed. There was no difference in operative time, post-operative complication (spontaneous abortion, threatened abortion, preterm labor or birth) between two groups. But Laparoscopic surgery had significant short hospital stay (3.7 1.0 vs 4.1 2.0days P 5 0.00) and less hemoglobin loss (1.0 0.2 vs 1.3 0.3 g/dl P 5 0.002) during operation than laparotomy. Threatened abortion and preterm labor were significant increased in emergency operation than elective operation (20.8% vs 2.6% P 5 0.028). Pregnancy outcomes were similar between laparoscopy and laparotomy.
Patient Characteristics and Perioperative Variables Variable
Laparoscopy
Laparotomy
P value
Gestational age at surgery (weeks) Hospital stay (days) Hemoglobin, decrease
14.3 5.3
12.1 6.3
0.619
3.7 1.0 1.0 0.2
4.1 2.0 1.3 0.3
0.000 0.002
P ! 0.05 significant, t-test Comparison of between emergency and elective operation Variable
Emergency
Elective
P value
Operating time(min) Preterm labor
67.218.1 5 (20.8%)
79.015.6 1 (2.6%)
0.008 0.028
P ! 0.05 significant, t-test Conclusion: There was no difference in pregnancy complication and prognosis between laparoscopy and laparotomy. Laparoscopic surgery can be managed safely and has more benefit than laparotomy in pregnancy women with adnexal mass. Especially to improve pregnancy outcome, it is important that we try to decrease the chance of emergency operation in pregnanct women.
453 Successful Pregnancy Outcome Following Laparoscopic Management of Heterotopic Pregnancy Jung US,1 Ju W,2 Lee SR.2 1Department of Obstetrics and Gynecology, Konyang University Hospital, Konyang University College of Medicine, Daejon, Republic of Korea; 2Department of Obstetrics and Gynecology, Ewha Womans University Mok-Dong Hospital, Seoul, Republic of Korea Study Objective: To investigate the safety and efficacy of laparoscopy management for heterotopic pregnancies in the first trimester of pregnancy. Design: Retrospective clinical study (Canadian Task Force classification III). Setting: University teaching hospital. Patients: Four heterotopic pregnant patients who developed significant abdominal pain during pregnancy. Intervention: Operative laparoscopy with insufflation pressure at 12 mmHg. Measurements and Main Results: Four patients had tubal pregnancies combined with intrauterine pregnancies, and laparoscopic salpingectomies were performed respectively. Median gestational age for the patients was 6þ5 weeks (5þ6 e 7þ2 weeks). Median age of the patients was 30 years (27 e 38 years). Median operating time was 27.5 minutes (20 e 55 minutes), and the median estimated blood loss was 17 mL (5 e 50 mL). No cases of conversion to laparotomy were noted. Median length of hospital stay was four days (3 e 7 days). There were no major obstetrical complications such as uterine contraction. Mean follow-up period was 14 months (7 e 21 months). All the patients delivered healthy term infants by two spontaneous vaginal deliveries and two cesarean sections. Median gestational age at delivery was 38 þ 4 weeks (37þ2 e 40þ6 weeks), and median birth weight was 3050 gm (2100 e 4000 gm).
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Conclusion: Laparoscopic management of the heterotopic pregnancy was performed successfully through an experienced surgeon, the availability of trained staff, and proper laparoscopic equipments. We add to the evidence that pregnancy outcome after laparoscopic surgery for the heterotopic pregnancy is satisfactory without increased morbidity and complications.
454 Incidence and Severity of Complications Related to Intraoperative Spillage of Teratoma Contents during Laparoscopic Surgery: Ten Year’s Experience Kim M, Cho Y, Lee C, Ko J, Choi H, Kim B. Obstetrics and Gynecology, Sanggye Paik Hospital, Seoul, Republic of Korea Study Objective: To evaluate the safety and efficacy of laparoscopic management of ovarian dermoid cysts without using endoscopic bag or culdotomy based upon our ten years’ experience. Design: Retrospective analysis of 81 cases of laparoscopic management of ovarian dermoid cysts since March 1999. Setting: Department of obstetrics and gynecology, Sanggye Paik Hosp, Inje university of school of medicine, Seoul, Korea. Patients: Eighty one women (ages 15-48 yrs, mean 29 yrs) who underwent laparoscopic removal of ovarian mature cystic teratoma(Histopathologically confrimed). Intervention: Laparoscopic ovarian cystectomy and salpingooophorectomy. Measurements and Main Results: Eighty-eight dermoid cysts with a mean diameter of 5.9 cm(2e12 cm) were removed in 81 patients. Fourty five cysts were on the right side and fourty three were on the left. Operative techniques used were cystectomy for 85 (96.6%) cysts and salpingooophorectomy for 3 (3.4%). All of the cysts were treated via enucleation followed by cystectomy or salpingo-oophorectomy and removal through a trocar sleeve without extension of incision for trocar site. None were treated via enucleation and removal within an endoscopic bag or by culdotomy. Spillage occurred for all of the 81 patients. Mean amount of irrigation fluid after spillage was 4.6 liters of normal saline. Mean operation time was 67 minutes(35-120 minutes), and there were no intraoperative complications. In two case, there were postoperative complications of an incisional hematoma below the umbilicus and postoperative fever. There was no postoperative chemical peritonitis. Conclusion: Laparoscopic management of dermoid cysts without using endoscopic bag, extension of incsion, and culdotomy, even though intraperitoneal spillage occurs, is a feasibe and beneficial method in terms of costs and cosmetics and does not increase postoperative morbidity when performed by an experienced laparoscopic surgeon and the pelvic cavity is thoroughly irrigated.
455 Robotic Resection of Cervical Myoma with Endocervical Tract Misconceived as Double Uterus Kim Y-J,1 Lee J-Y,2 Park M-I,1 Cho S-H.1 1OBGYN, Hanyang University Medical Center, Seoul, Republic of Korea; 2Minimal Invasive Surgery, Anh’s Women’s Clinic, Seoul, Republic of Korea Study Objective: To present the successful management of cervical leiomyoma with endocervical tract misconceived as double uterus. Design: Report of clinical hystory and surgical procedure. Setting: University hospital. Patients: 34 years old, Nullipara woman. Transferred from local private clinic after D&E for missed abortion. Intervention: In this presentation, we present successful management of cervical fibroid with endocervical tract misconceived as double uterus using da Vinci surgical robot. Measurements and Main Results: Large degenerated cervical fibroid was resected with assistance of surgical robot and intratumoral tract extended to endocervical canal was repaired with absorbable suture in 2 layers.
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S103eS157
due to underlying pathology. Excluded were cases that had to be repaired via laparotomy. Setting: Tertiary referal medical center. Patients: 10345 laparoscopic gynecological cases were reviewed. 12 cases (median age of 45.5) of ureter transections were diagnosed (lower 1/3) and repaired laparoscopically. 83.3% had previous surgeries, pelvic adhesions or a large pelvi-abdominal mass. Intervention: 1 case had undergone a segmental resection and ureteroureterostomy for infiltrative endometriosis. Of the remaining 11 iatrogenic ureteral transections, 10 were repaired via uretero-ureterostomy while 1 had undergone an ureteroneocystostomy.
The BMI mean was 26.51 kg/m3. Tumor size has a significant positive impact on surgery time (p 5 0.0205) and number of tumors had a significant positive impact on console time (p 5 0.0246). Tumor size, number of leiomyomata, console time, and non console time, are statistically significant positive impact on the blood loss with p value of 0.0031, 0.0181, 0.0001, and 0.0002 respectively. Conclusion: da Vinci robotic equipment has made the laparoscopic myomectomy procedure more precise, with less blood loss and technically easier for the surgeon. It provides the patient with a shorter hospital stay, less post operative pain, quicker return to normal activities and less scarring.
451 Ipsilateral Ovarian Pregnancy after Vaginal Salpingectomy: A Case Report Hong S-Y, Kim D-W, Shin J-W, Park W-I, Seo Y-S. Obstetrics and Gynecology, Eulji Hospital, School of Medicine Eulji University, Seoul, Republic of Korea
1 injury was recognized on the 2nd post-operative day, but intra-operative recognition was attained in 11 cases (91.7%). Measurements and Main Results: The median duration of DJ stenting was 73 days. 3 developed strictures (between 42 e 79 days post operation) treated with restenting, but 1 had to undergo an ureteroneocystostomy for ureter disruption. 1 developed leakage of the anastomotic site but recovered with a change of DJ stent. All the patients were well and asymptomatic at the conclusion of this study period. Conclusion: Early recognition and treatment of ureteral injuries are important to prevent morbidity. Laparoscopic uretero-ureterostomy should be attempted in transections of lower 1/3 ureter where technical expertise is available.
Study Objective: To report a rare case of ipsilateral ovarian pregnancy, recurrent type after vaginal salpingectomy for tubal pregnancy, which was successfully treated laparoscopic operation. Design: Case report. Setting: University Hospital, Seoul. Patients: A 21-year-old women who resented at 11 þ 5 wwks of amenorrhea with acute abdominal pain and vaginal bleeding for 2 days. Past medical history included vaginal salpingectomy for right ampullary pregnancy 2 years ago at other Unversity hospital in Seoul, Korea. Intervention: On admission transvaginal ultrasonogam showed normal uterine shape without any evidence of IUP, and right adnexal mass(6X5.5X5.8 cm) which was mainly soli mass with a central hypoechoic portion. The pregnancy test was positive. Initial Impressions were 1) ectopic pregnancy with right ovarian mass, or 2) ovaria pregnancy. Measurements and Main Results: Laparoscopic operation was performed. Intraopratively there as a mandarin orange sized ovary, which was bluish discoloration and cogestion on the surface. Right oophorectomy was performed. Histopathologic examination confirmed the diagnosis of the ovarian regnancy. The postoprative course was uneventful. Conclusion: The case of the ipsilateral ovarin pregnancy after vagianl salingectomy for tubal pregnancy, which was successfully treated with laparoscopic operation, is presented.
450 da Vinci Robotic Laparoscopic Myomectomy Hanafi MM. Gynecology, Saint Joseph’s Hospital of Atlanta, Atlanta, GA Study Objective: To report patients who underwent Robotic laparoscopic myomectomy using the da Vinci robotic system and the factors affecting the total operating time, console time and total blood loss. Design: Retrospective study of a consecutive case series. Setting: Tertiary care facility. Patients: A total of seventy patients with symptomatic leiomyomata. Intervention: Robotic Myomectomy was administered. Measurements and Main Results: Between February 2007 and January 2009, 70 patients (23-57 years) underwent robotic laparoscopic Myomectomy. Out of the 70 patients, 51 patients information was fully obtained. The patient’s data included: total operating time(minutes), console time(minutes),Non console time, estimated blood loss(ml), length of hospital stay(days), number of leiomyomata, tumors size(mm), age (years) and body mass index(kg/m3). Statistical analysis was performed using SAS 9.1 software. A pevalue of less than 0.05 was considered statistically significant. The operating time mean was 204.05 minutes. Console time mean was 99.45 minutes. Non Console time mean was 104.6 min. Blood loss mean was 104.60 ml. Average number of leiomyomata was 3 .Tumor size mean was 43.16. Average length of the hospital stay was 1day. The age mean at the time of surgery was 39 years.
452 Comparison of Pregnancy Prognosis by Surgical Management for Adnexal Mass in Pregnancy Jeung IC. OB&GYN, Daejeon St. Mary’s Hospital, Joong-gu, Daejeon, Republic of Korea Study Objective: To compare pregnancy prognosis by surgical management methods for adnexal mass in pregnancy, we evaluated laparoscopic surgery and laparotomy. Design: Between January 2000 and April 2008, St. Mary’s hospital, Kangnam St. Mary’s hospital, and Daejeon St. Mary’s hospital were included. We performed a systemic retrospective chart review of patient who received by exploratory laparotomy or laparoscopy. Setting: The following factors were assessed: preoperative diagnosis, gestational age at the time of surgery, operative time, hospital stay, pathology, gestational age at delivery, complication and pregnancy outcome in both groups. Student’s t-test and Fisher’s exact test were used for statistical analysis. P-vlaue below 0.05 was considered statistically significant. Patients: 62 patients diagnosed with adnexal mass in pregnancy. Intervention: N/A
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S103eS157 Measurements and Main Results: Laparoscopy 23 cases and exploratory laparotomy 39 cases underwent surgery during the study period. Lower abdominal pain due to cystic mass (50.0%) was the first operative indication and cystic torsion (30.6%) was followed. There was no difference in operative time, post-operative complication (spontaneous abortion, threatened abortion, preterm labor or birth) between two groups. But Laparoscopic surgery had significant short hospital stay (3.7 1.0 vs 4.1 2.0days P 5 0.00) and less hemoglobin loss (1.0 0.2 vs 1.3 0.3 g/dl P 5 0.002) during operation than laparotomy. Threatened abortion and preterm labor were significant increased in emergency operation than elective operation (20.8% vs 2.6% P 5 0.028). Pregnancy outcomes were similar between laparoscopy and laparotomy.
Patient Characteristics and Perioperative Variables Variable
Laparoscopy
Laparotomy
P value
Gestational age at surgery (weeks) Hospital stay (days) Hemoglobin, decrease
14.3 5.3
12.1 6.3
0.619
3.7 1.0 1.0 0.2
4.1 2.0 1.3 0.3
0.000 0.002
P ! 0.05 significant, t-test Comparison of between emergency and elective operation Variable
Emergency
Elective
P value
Operating time(min) Preterm labor
67.218.1 5 (20.8%)
79.015.6 1 (2.6%)
0.008 0.028
P ! 0.05 significant, t-test Conclusion: There was no difference in pregnancy complication and prognosis between laparoscopy and laparotomy. Laparoscopic surgery can be managed safely and has more benefit than laparotomy in pregnancy women with adnexal mass. Especially to improve pregnancy outcome, it is important that we try to decrease the chance of emergency operation in pregnanct women.
453 Successful Pregnancy Outcome Following Laparoscopic Management of Heterotopic Pregnancy Jung US,1 Ju W,2 Lee SR.2 1Department of Obstetrics and Gynecology, Konyang University Hospital, Konyang University College of Medicine, Daejon, Republic of Korea; 2Department of Obstetrics and Gynecology, Ewha Womans University Mok-Dong Hospital, Seoul, Republic of Korea Study Objective: To investigate the safety and efficacy of laparoscopy management for heterotopic pregnancies in the first trimester of pregnancy. Design: Retrospective clinical study (Canadian Task Force classification III). Setting: University teaching hospital. Patients: Four heterotopic pregnant patients who developed significant abdominal pain during pregnancy. Intervention: Operative laparoscopy with insufflation pressure at 12 mmHg. Measurements and Main Results: Four patients had tubal pregnancies combined with intrauterine pregnancies, and laparoscopic salpingectomies were performed respectively. Median gestational age for the patients was 6þ5 weeks (5þ6 e 7þ2 weeks). Median age of the patients was 30 years (27 e 38 years). Median operating time was 27.5 minutes (20 e 55 minutes), and the median estimated blood loss was 17 mL (5 e 50 mL). No cases of conversion to laparotomy were noted. Median length of hospital stay was four days (3 e 7 days). There were no major obstetrical complications such as uterine contraction. Mean follow-up period was 14 months (7 e 21 months). All the patients delivered healthy term infants by two spontaneous vaginal deliveries and two cesarean sections. Median gestational age at delivery was 38 þ 4 weeks (37þ2 e 40þ6 weeks), and median birth weight was 3050 gm (2100 e 4000 gm).
S123
Conclusion: Laparoscopic management of the heterotopic pregnancy was performed successfully through an experienced surgeon, the availability of trained staff, and proper laparoscopic equipments. We add to the evidence that pregnancy outcome after laparoscopic surgery for the heterotopic pregnancy is satisfactory without increased morbidity and complications.
454 Incidence and Severity of Complications Related to Intraoperative Spillage of Teratoma Contents during Laparoscopic Surgery: Ten Year’s Experience Kim M, Cho Y, Lee C, Ko J, Choi H, Kim B. Obstetrics and Gynecology, Sanggye Paik Hospital, Seoul, Republic of Korea Study Objective: To evaluate the safety and efficacy of laparoscopic management of ovarian dermoid cysts without using endoscopic bag or culdotomy based upon our ten years’ experience. Design: Retrospective analysis of 81 cases of laparoscopic management of ovarian dermoid cysts since March 1999. Setting: Department of obstetrics and gynecology, Sanggye Paik Hosp, Inje university of school of medicine, Seoul, Korea. Patients: Eighty one women (ages 15-48 yrs, mean 29 yrs) who underwent laparoscopic removal of ovarian mature cystic teratoma(Histopathologically confrimed). Intervention: Laparoscopic ovarian cystectomy and salpingooophorectomy. Measurements and Main Results: Eighty-eight dermoid cysts with a mean diameter of 5.9 cm(2e12 cm) were removed in 81 patients. Fourty five cysts were on the right side and fourty three were on the left. Operative techniques used were cystectomy for 85 (96.6%) cysts and salpingooophorectomy for 3 (3.4%). All of the cysts were treated via enucleation followed by cystectomy or salpingo-oophorectomy and removal through a trocar sleeve without extension of incision for trocar site. None were treated via enucleation and removal within an endoscopic bag or by culdotomy. Spillage occurred for all of the 81 patients. Mean amount of irrigation fluid after spillage was 4.6 liters of normal saline. Mean operation time was 67 minutes(35-120 minutes), and there were no intraoperative complications. In two case, there were postoperative complications of an incisional hematoma below the umbilicus and postoperative fever. There was no postoperative chemical peritonitis. Conclusion: Laparoscopic management of dermoid cysts without using endoscopic bag, extension of incsion, and culdotomy, even though intraperitoneal spillage occurs, is a feasibe and beneficial method in terms of costs and cosmetics and does not increase postoperative morbidity when performed by an experienced laparoscopic surgeon and the pelvic cavity is thoroughly irrigated.
455 Robotic Resection of Cervical Myoma with Endocervical Tract Misconceived as Double Uterus Kim Y-J,1 Lee J-Y,2 Park M-I,1 Cho S-H.1 1OBGYN, Hanyang University Medical Center, Seoul, Republic of Korea; 2Minimal Invasive Surgery, Anh’s Women’s Clinic, Seoul, Republic of Korea Study Objective: To present the successful management of cervical leiomyoma with endocervical tract misconceived as double uterus. Design: Report of clinical hystory and surgical procedure. Setting: University hospital. Patients: 34 years old, Nullipara woman. Transferred from local private clinic after D&E for missed abortion. Intervention: In this presentation, we present successful management of cervical fibroid with endocervical tract misconceived as double uterus using da Vinci surgical robot. Measurements and Main Results: Large degenerated cervical fibroid was resected with assistance of surgical robot and intratumoral tract extended to endocervical canal was repaired with absorbable suture in 2 layers.