3D Imaging Reconstruction and Laparoscopic Robotic Surgery Approach to Disseminated Peritoneal Leiomyomatosis

Study objective: This video article explores the synergistic approach of 3-dimensional (3D) imaging reconstruction and laparoscopic robotic surgery for the management of a complex case of disseminated peritoneal leiomyomatosis [1]. The primary focus lies in the capability of the reconstruction model to provide diagnostic support to identify myomas during surgical procedures, potentially enhancing surgical precision, reducing operating times, minimizing uterine incisions, and limiting blood loss. 3D imaging reconstruction techniques were used to facilitate the identification of multiple parasitic and nonserosal myomas, which is particularly challenging when operating with a robotic surgical platform that lacks haptic feedback.

Design: A case report design was used, focusing on a 43-year-old nulliparous infertile woman with multiple symptomatic uterine myomas. Our institution has made a further diagnosis of disseminated peritoneal leiomyomatosis [2,3].

Setting: Tertiary referral center.

Interventions: Owing to the widespread nature of peritoneal leiomyomatosis and numerous uterine myomas, robotic surgery was considered a preferable option based on our experience to operate within confined anatomic spaces. 3D imaging reconstruction technology was used for preoperative and intraoperative planning, enabling precise determination of the myomas' location, size, and volume obtained through magnetic resonance imaging. Real-time 3D imaging guided rapid myoma localization and surgical strategy adjustment [4,5]. The procedure resulted in the removal of 15 myomas, with minimal blood loss (250 mL) and a total operative time of 120 minutes. Multilayer running hysterorrhaphy was performed using a barbed monofilament suture to ensure effective hemostasis, incorporating serosal introflection to reduce the risk of postoperative adhesion development.

Conclusion: The combined approach of 3D imaging reconstruction and laparoscopic robotic surgery holds significant potential for the management of disseminated peritoneal leiomyomatosis. This approach can overcome some robotic surgery limitations, particularly the absence of haptic feedback, providing accurate preoperative planning and real-time intraoperative guidance, facilitating efficient myoma localization, minimizing uterine incisions, and reducing blood loss. Further research is needed to fully evaluate the clinical impact of this promising technology.