Laparoscopic Single Site Techniques in Management of Fibroid Pain during Pregnancy

Abstract

<h3>Study Objective</h3> To demonstrate tips and tricks for the successful use of single site laparoscopic surgery for myomectomy during pregnancy. <h3>Design</h3> Stepwise demonstration with narrated video footage. <h3>Setting</h3> An academic tertiary care hospital. <h3>Patients or Participants</h3> Our patient is a 39-year-old G1P0 with a symptomatic 12cm degenerating pedunculated fibroid refractory to conservative pain management. <h3>Interventions</h3> Recent literature has indicated that the majority of laparotomic myomectomies performed during pregnancy showed overall positive pregnancy outcomes and low complications. This indicates that myomectomy in pregnancy is safe and can be utilized in cases unresponsive to conservative management. However, cases in literature discussing the single-site techniques for laparoscopic myomectomy during pregnancy has been sparse. Utilizing laparoscopy in myomectomy during pregnancy, permits decreased postoperative pain, quicker recovery, and lowered risk of post-operative complications. Single site laparoscopic surgery also aids in improved patient cosmesis and can be utilized for the fibroid removal. Literature has demonstrated that laparoscopic single site is safe and feasible during all stages of pregnancy. Nevertheless, this approach may be challenging for unexperienced surgeons due to the lack of triangulation and crowding of instruments in single site laparotomy. Tips and Tricks: 1. Utilizing the open-Hasson-technique 2. Placing a suture in the fibroid stalk 3. Surgeon possessing expertise in single site surgery 4. Minimizing manipulation of the uterus 5. V-loc sutures 6. Placement of a 5 mm accessory port 7. Using gentle traction 8. Leaving a stump of more than 1 cm. <h3>Measurements and Main Results</h3> The estimated blood loss was 50cc and the total operative time was 123 minutes. She had an unremarkable postoperative course, no medications were needed for pain management, and was discharged home on post-operative day 2. At 38 weeks, she successive delivered with elective cesarean delivery with no complications. <h3>Conclusion</h3> Single incision laparoscopic surgery myomectomy is a practical technique in women refractive to conservative management. When performed by an experienced surgeon the patient can benefit from faster specimen removal and recovery.