子宮肌瘤是育齡婦女最常見的婦科疾病之一，由子宮肌層的平滑肌和結締組織異常增生所致，可能導致病人出現月經量多、貧血等症狀。若已造成日常與工作上的困擾，手術切除肌瘤能提升生活品質；對於未來有生育計劃或是體質虛弱的婦女病人來說，達文西手術明顯減少疼痛、降低失血量及降低輸血需要、縮短住院天數、恢復期較快，能助您更早復原回歸正常活動，是建議的手術選項之一。
發生率高 達文西手術切除子宮肌瘤案例多
子宮肌瘤多發生在 30 歲以上的女性，且發病率高達 20%。常見症狀除月經血量多、不正常出血、經痛、性交疼痛外，少數的人還會有不孕的問題；若肌瘤太大，壓迫到泌尿系統還會出現血崩、眩暈貧血、解尿困難，或是腎積水及頻尿情形；若是子宮肌瘤發生扭轉，也可能造成急性疼痛。
達文西機械手臂系統目前已廣泛應用到婦科手術中，如子宮肌瘤切除手術、子宮切除手術、卵巢囊腫切除手術、子宮內膜異位症、子宮內膜癌手術、子宮頸癌手術等。
由於發生頻率高，因此達文西手術應用於子宮肌瘤切除的比例也相對高，約佔國內達文西手術總量的三分之一。比起傳統的腹腔鏡子宮肌瘤切除手術，達文西手臂可以切除更大、更多、更困難切除的子宮肌瘤。
依肌瘤位置 微創達文西手術可能無創
子宮肌瘤根據生長的位置，可分為肌肉層肌瘤、漿膜下肌瘤及黏膜下肌瘤三大類型。依據位置不同，醫師會評估達文西機械手臂的進入著力點，一般來說會在腹腔上切出 2 至 3 個約 0.5 至 1 公分的細小切口，讓器械伸入體內切除；但臨床上也有從陰道進入切除肌瘤的案例，肚皮不留疤。
模仿人類手腕關節設計的手術器械——達文西機械手臂微創手術系統，操作上精密準確，避免了人手可能發生的震顫情形；影像處理上，系統具備高解析度 3D 放大影像，使醫師手術視野更清晰。透過達文西手臂進行手術，醫師僅需少數微小開口，即能進行複雜的高難度手術，比起傳統手術可以大幅縮短恢復期，幫助患者快速恢復正常生活。
術後懷孕機率高 沾黏發生率降低
比起傳統開腹與腹腔鏡的較大傷口，達文西手術的傷口小上許多，手術出血量少、子宮傷口縫合效果較佳，子宮結構完整未被過度破壞，因此手術後更能創建一個適合懷孕及生產的子宮環境。
也有病人擔心術後沾黏問題。沾黏是身體啟動了自我修復的能力，在修復的過程中若把附近的組織都連結在一起，好發於腹腔手術後；但由於達文西手臂手術傷口小，術後發炎反應少，因此沾黏發生率也較低。
在子宮肌瘤切除手術上，該選擇達文西手臂還是腹腔鏡手術？臨床研究曾針對達文西與腹腔鏡兩種手術方式進行比較，結果顯示，在子宮肌瘤切除手術上，雖然達文西手術時間稍長，但可能因達文西手術在傷口縫合上表現較佳，術後的出血量相對腹腔鏡手術者來得少，因此術後併發症也較低。
子宮肌瘤與女性的雌激素有關。更年期前，女性的雌激素會刺激子宮肌瘤一直長大；停經後雌激素下降，子宮肌瘤生長才可能停滯。每人體質不同，手術切除後的肌瘤也有復發可能。若您也深受其擾，建議您視影響程度與個人狀況，與醫師諮詢治療方法。
English Version｜Robotic Surgery for Uterine Fibroids
Uterine fibroids are among the most common gynecologic conditions in women of reproductive age. They arise from abnormal proliferation of smooth muscle and connective tissue within the myometrium, and may cause heavy menstrual bleeding and anemia. When symptoms interfere with daily life or work, surgical removal can improve quality of life.
For patients planning future pregnancy or those in a more fragile physical condition, robotic surgery offers meaningfully less pain, reduced blood loss and transfusion requirement, shorter hospital stay, and faster recovery — making it one of the recommended surgical options.
High Prevalence and Frequent Robotic Application
Uterine fibroids most commonly occur in women over 30, with a prevalence of up to 20%. Common symptoms include heavy menstrual bleeding, abnormal bleeding, dysmenorrhea, and pain during intercourse; a minority of patients experience infertility. Large fibroids compressing the urinary tract may cause severe bleeding, dizziness from anemia, difficulty voiding, hydronephrosis, or urinary frequency. Torsion of a fibroid may cause acute pain.
Robotic surgical systems are now widely applied in gynecology, including myomectomy, hysterectomy, ovarian cystectomy, endometriosis surgery, and surgery for endometrial and cervical cancer.
Given the high prevalence of fibroids, myomectomy accounts for a correspondingly large share of robotic procedures — approximately one third of all robotic surgeries performed in Taiwan. Compared with conventional laparoscopic myomectomy, the robotic approach allows removal of fibroids that are larger, more numerous, or more technically demanding.
Approach Depends on Fibroid Location
Uterine fibroids are classified by location into three main types: intramural, subserosal, and submucosal. Depending on the location, the surgeon determines the optimal port placement. Typically, two to three small incisions of 0.5 to 1 cm are made in the abdomen. In selected cases, a transvaginal approach has also been performed, leaving no abdominal scar.
The robotic system uses instruments designed to replicate the movement of the human wrist, providing precise operation while eliminating natural hand tremor. Its high-resolution, magnified 3D imaging offers a clearer operative field. Through only a few small ports, complex procedures can be completed, substantially shortening the recovery period compared with open surgery.
Fertility Outcomes and Reduced Adhesion Formation
Compared with the larger incisions of open and conventional laparoscopic surgery, robotic surgery involves considerably smaller wounds, less intraoperative blood loss, and better uterine closure. The structural integrity of the uterus is better preserved, which supports a uterine environment more favourable for future pregnancy and delivery.
Some patients are concerned about post-operative adhesions. Adhesions occur when the body’s healing response binds adjacent tissues together, and they are common after abdominal surgery. Because robotic surgery involves smaller wounds and provokes less inflammatory response, the incidence of adhesion formation is lower.
Should patients choose robotic or laparoscopic myomectomy? Clinical studies comparing the two approaches have shown that although robotic procedures take somewhat longer, the superior quality of wound closure is associated with less post-operative blood loss and consequently fewer complications.
Uterine fibroids are estrogen-dependent. Before menopause, estrogen stimulates continued fibroid growth; after menopause, declining estrogen levels may halt further growth. Individual responses vary, and fibroids may recur after surgical removal. If fibroids are affecting your daily life, discuss treatment options with your physician based on the severity of your symptoms and your personal circumstances.
婦科腫瘤與子宮內膜癌微創手術評估
- 陳威君醫師｜婦科腫瘤／婦癌專科・副教授級主治醫師
- 專長：海扶刀、單孔達文西微創手術、微波消融治療
- 門診：林口長庚紀念醫院、土城長庚紀念醫院
- 門診諮詢｜LINE 搜尋：@hifudr
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