Week 3: Pei Wen

This week, I was most astonished by the robot-assisted and open surgery myomectomies, surgical procedure to remove uterine fibroids, we observed early in the week. Coincidentally, both myomectomies were performed on the same day, so it was especially interesting to compare and contrast both strategies for myomectomies. Compared to the minimally invasive hysteroscopic fibroid removals we observed in our first week, these myomectomies were more time-intensive, taking 3-4 hours each and required more precise and deeper cuts as the fibroids were larger in these cases. In the context of the robot-assisted surgery, it was reminiscent of the hysterectomies performed last week where the internal abdomen and uterus were accessed through a small incision at the umbilicus supplemented with additional smaller port sites to accommodate the robotic arms. For the technology itself, I was surprised by the resolution, depth, and precision the robot and associated interface offered. While Dr. Fenster is accustomed to robot-assisted surgeries, she mentioned tactility and pressure sensitivity were features that were lacking for this approach. For the surgery itself, I was surprised by the many layers of tissue of the uterus and how deep the incision needed to be to remove the fibroid in this case. As such, I was unsure about the suturing process, but I learned that, contrary to my initial assumption of a single pass, the closure was performed in multiple passes, beginning with the deepest layer and progressing outward. In the context of the open surgery approach, the process was comparatively more invasive, requiring a few centimeters incision at the abdomen. Surprisingly, there was less bleeding compared to the robot-assisted approach. Dr. Fenster informed us that most patients prefer open surgery, as it was considered more cosmetically pleasing. However, recovery is typically faster in robot-assisted cases.