Single-port Laparoscopic Myomectomy Research Articles

A retrospective analysis of single-port laparoscopy in myoma management

ObjectiveThis study assesses the effectiveness and safety of single-port laparoscopic myomectomy (SPLM) versus conventional laparoscopic myomectomy (CLM). MethodsWe conducted a retrospective case-control study at a university tertiary hospital, involving 262 patients treated from July 2020 to December 2022. Participants were divided into two groups: 132 underwent SPLM and 130 underwent CLM. ResultsThe two groups were comparable in terms of age, body mass index, parity, delivery history, preoperative anemia, number of myomas, and size of the largest myoma. The SPLM group showed a significant reduction in operation time (average 93 min) and estimated blood loss (average 50 ml) compared to the CLM group (average 118.5 min and 100 ml, respectively). Subgroup analysis based on the size, location, and number of myomas further highlighted the advantages of SPLM, particularly for patients with large (diameter ≥8 cm) or multiple myomas (number ≥4). Patient satisfaction was also notably higher in the SPLM group. ConclusionsSingle-port laparoscopic myomectomy offers a highly effective, safer, and patient-preferred option for the surgical management of fibroids, especially in cases of large or multiple myomas. These findings suggest that SPLM could become the preferred surgical approach for complex fibroid cases, promising less trauma and quicker recovery for patients.

P-738 Reproductive surgery for fertility preservation: Robotic single-port myomectomy (da Vinci® SP) versus robotic single-site myomectomy (da Vinci® Xi or Si)

Abstract Study question To compare clinical and surgical outcomes of robotic single-port myomectomy using da Vinci® SP and robotic single-site myomectomy with Xi or Si for fertility preservation. Summary answer The robotic single-port myomectomy (da Vinci® SP) might be feasible, even if the myoma is deep-seated, compared to robotic single-site myomectomy (Xi or Si system). What is known already Myomas are clinically apparent in about 25% of women and become symptomatic in their reproductive age. Myomectomy is the choice of treatment for women desiring uterine preservation, especially in deep-seated fibroid that can affect pregnancy. Although young women prefer minimal invasive surgical technique with less scar, single-port laparoscopic myomectomy has some limitations. Adoption of the da Vinci® system made it possible to overcome the weaknesses of laparoscopy. Owing to the ability of single-port laparoscopy to reduce pain and improve patient satisfaction, robotic single-site surgery was developed in order of the da Vinci® Si, Xi and the latest new SP system. Study design, size, duration We retrospectively reviewed medical records of 214 patients who underwent robotic single-port myomectomy (RSPM, n = 111) using the da Vinci® SP surgical system or robotic single-site myomectomy (RSSM, n = 103) with the da Vinci® Xi or Si system between October 2015 and September 2023 at Ewha Womans University Mokdong Hospital. Baseline characteristics and operative outcomes were compared and analyzed between the RSPM and RSSM groups. Participants/materials, setting, methods We assessed FIGO classification and maximum diameter of fibroid. The incision time, docking time, console time, wound closure time, total operation time, estimated blood loss (EBL), chopping time for specimen removal, the number and weight of removed myoma were measured. Main results and the role of chance Mean age (38.5±6.6 vs 37.3±6.6 years) and anthropometric index were not significantly different between RSPM and RSSM groups. Although the diameter (7.1±1.4 vs 7.2±2.0 cm), number (3.1±2.7 vs 2.5±2.2), and weight (149.1±107.1 vs 146.4±130.6 g) of myoma were not significantly different between the two groups, the more deep-seated myoma diagnosed by FIGO classification (2.9±1.5 vs 4.6±2.0, p<0.0001) could be resected in RSPM group. The incision (3.6±1.9 vs 7.3±4.4 min, p <0.0001) and docking time (2.7±1.4 vs 4.6±1.6 min. p<0.0001) were less in the group of RSPM compared to RSSM that was earlier implementation. Depending on the differences in da Vinci® SP and Xi or Si systems, the wound was slightly larger, requiring shorter chopping time (6.4±5.0 vs 8.4±7.2 min, p=0.022) and longer closure time (12.8±4.4 vs 10.9±3.6 min, p=0.001) in the RSPM group. Additionally, more complex surgeries with larger blood loss (264.1±140.2 vs 176.8±132.0 ml, p<0.0001), longer console time (60.5±33.2 vs 49.7±22.6 min, p=0.016) and hospitalization (4.6±0.9 vs 4.3±0.6 days, p=0.005) were performed in the RSPM group, but the difference in hemoglobin (2.5±1.0 vs 2.6±0.9 g/dL) before and after surgery was not significant. Limitations, reasons for caution All surgeries underwent using the da Vinci systems by one gynecologic surgeon who had experience performing almost 2,000 gynecologic robotic surgeries and the follow-up period was not enough to conclude the reproductive outcome. Wider implications of the findings The RSPM using the da Vinci® SP surgical system could be recommended for patient who planned future pregnancy. However, the optimal surgical technique should be selected for successful fertility preservation of reproductive surgery. Trial registration number 2023-03-038

The merging of dual umbilical port-incisions for contained morcellation in laparoscopic myomectomy

Uncontained power morcellation during laparoscopic myomectomy may spread tissue fragments or malignant cells into the abdominal cavity. Recently, various approaches to contained morcellation, have been adopted to retrieve the specimen. However, each of these methods has its own drawbacks. Intraabdominal bag-contained power morcellation adopts a complex isolation system, which prolongs the operation and increases medical costs. Contained manual morcellation via colpotomy or mini-laparotomy increases the trauma and the risk of infection. Contained manual morcellation via umbilical incision during single-port laparoscopic myomectomy may be the most minimally invasive and cosmetic approach. But the popularization of single-port laparoscopy is challenging because of technical difficulties and high costs. We have therefore, developed a surgical technique using 2 umbilical port-incisions (5 mm and 10 mm), which are merged into 1 large umbilical incision (25-30mm) for contained manual morcellation during specimen retrieval, and one 5mm incision in the lower left abdomen for an ancillary instrument. As demonstrated in the video, this technique significantly facilitates surgical manipulation using conventional laparoscopic instruments while still keeping the incisions minimal. It is also economical because the use of an expensive single-port platform and special surgical instruments is avoided. In conclusion, the merging of dual umbilical port-incisions for contained morcellation adds a minimally invasive, cosmetic, and economical option to laparoscopic specimen retrieval that would enrich a gynecologist's skill set, which is particularly relevant in a low-resource settings.

Comparison of Surgical Outcomes between Single-Port Laparoscopic Surgery and Da Vinci Single-Port Robotic Surgery.

The aim of this study is to compare the surgical outcomes of single-port laparoscopic surgery (SPLS) and single-port robotic surgery (SPRS). We retrospectively analyzed patients who underwent a hysterectomy, ovarian cystectomy, or myomectomy with SPLS or SPRS from January 2020 to July 2022. Statistical analyses were performed using the SPSS chi-square test and student's t-test. A total of 566 surgeries including single-port laparoscopic hysterectomy (SPLH; n = 148), single-port robotic hysterectomy (SPRH; n = 35), single-port laparoscopic ovarian cystectomy (SPLC; n = 207), single-port robotic ovarian cystectomy (SPRC; n = 108), single-port laparoscopic myomectomy (SPLM; n = 12), and single-port robotic myomectomy (SPRM; n = 56). The SPRH, SPRC, and SPRM groups had a shorter operation time than the SPLS group, although the results were not statistically significant (SPRH vs. SPLH, p = 0.134; SPRC vs. SPLC, p = 0.098; SPRM vs. SPLM, p = 0.202). Incisional hernia occurred as a postoperative complication in two patients only in the SPLH group. Postoperative Hb changes were lower in the SPRC and SPRM groups than in the SPLC and SPLM groups (SPRC vs. SPLC, p = 0.023; SPRM vs. SPLM, p = 0.010). Our study demonstrated that the SPRS had comparable surgical outcomes when compared to the SPLS. Therefore, the SPRS should be considered a feasible and safe option for gynecologic patients.

Application Progress of Transumbilical Single-Port Laparoscopic Surgery for Myomectomy

Uterine fibroids are the most common gynecological benign tumors in women during reproductive period, which often lead to anemia, abortion, infertility, and seriously affect the physical and mental health of patients. At present, the treatment of uterine fibroids includes conservative observation, drug therapy and surgical treatment. For patients with uterine preservation needs, laparoscopic myomectomy is currently the preferred surgical method for uterine fibroid preservation. In recent years, with the development of minimally invasive technology, transumbilical single-site surgery (TU-LESS) has been widely used in gynecological minimally invasive surgery. Compared with traditional laparoscopic surgery, TU-LESS can not only ensure the operation effect, but also has the advantages of less trauma, faster recovery and no trace after operation, especially suitable for female patients; However, due to the problems of limited visual field, "chopstick effect", difficulty in forming "operation triangle", difficulty in suturing and tumor extraction, the application of TU-LESS in myomectomy is relatively backward, and there are still many surgical difficulties to be overcome in the process of operation, which requires a certain learning curve to master the surgical skills. With the continuous practice and exploration, the application of transumbilical single-port laparoscopic myomectomy (SPLM) will become more and more mature with the summary of operation skills and the invention of special instruments. This article reviews the application progress of transumbilical single-port laparoscopy in myomectomy and the key points and difficulties in learning this operation.

Robotic single-port myomectomy using the da Vinci SP surgical system: A pilot study.

To report our initial experience with robotic single-port myomectomy (RSPM) using the da Vinci SP surgical system and to evaluate the feasibility of the procedure. This prospective observational study was performed at a university teaching hospital from January 2019 to December 2019. Sixty-one women with symptomatic fibroids received RSPM. Based on seven resected fibroids and a maximal diameter of resected fibroids <10cm, the women were arbitrarily divided into two groups. The mean number and maximal diameter of the removed fibroids were 3.7 ± 3.8 (2.3 ± 1.8 in Group 1 vs. 7.2 ± 5.3 in Group 2) and 7.6 ± 2.9cm (6.8 ± 1.6 in Group 1 vs. 9.5 ± 4.3 in Group 2), respectively. The mean operation time, hemoglobin change, and hospital stay were 149.9 ± 72.9min (123.8 ± 43.8 in Group 1 vs. 217.6 ± 89.4 in Group 2), 2.3 ± 1.0g/dL (2.1 ± 0.9 in Group 1 vs. 2.7 ± 1.2 in Group 2), and 4.5 ± 0.8 days (4.4 ± 0.8 in Group 1 vs. 4.7 ± 0.9 in Group 2). There was no conversion to multi-port laparoscopy or laparotomy nor were there any major complications. RSPM using the da Vinci SP surgical system is feasible surgical modality for women with symptomatic fibroid and is expected to increase indications of single-port myomectomy by solving many of the ergonomics problems inevitably accompanying single-port laparoscopic myomectomy.

Application of Single-Port Laparoscopic Surgery in Myomectomy.

Research QuestionThe use of a power morcellator in laparoscopic myomectomy is a controversial topic. The application of single-port laparoscopy solves this problem, but its safety, efficacy and prognosis are also challenges. The purpose of this study was to compare the clinical application of single-port laparoscopy and traditional three-port laparoscopy in myomectomy.DesignThis is a retrospective review of a total of 120 patients who underwent single-port laparoscopic myomectomy (n=60) or traditional three-port laparoscopic myomectomy (n=60), performed between January 2019 to December 2020. The operation time, intraoperative blood loss, specimen removal time, hemoglobin change after operation, postoperative ambulation time, first exhaust time after surgery, the length of hospital stay, pain score on the day, the first day after operation and the satisfaction of abdominal wall scar were evaluated for the surgical outcomes.ResultsCompared with the traditional three-port laparoscopic group, the specimen removal time, postoperative ambulation time, first exhaust time after surgery, the length of hospital stay were all shorter, the satisfaction of abdominal wall scar were higher in single-port laparoscopic group. The duration of surgery was longer in single-port laparoscopic group significantly. The differences were statistically significant (P<0.05). The intraoperative blood loss, hemoglobin change after operation, pain score on the day of operation and the first day after operation of the two groups had no differences (P>0.05).ConclusionsThe clinical effect of single-port laparoscopic myomectomy is satisfactory and can be popularized in clinic.

Operative and Obstetric Outcomes after Single-port Laparoscopic Myomectomy: A Retrospective Single-center Analysis of 504 Cases

To analyze the obstetric and operative outcomes of 504 cases of single-port laparoscopic myomectomy (SPLM). Single-center retrospective study. A tertiary university hospital. A total of 502 patients (504 SPLM procedures) who underwent SPLM for symptom relief or growing myomas between October 2009 and April 2020. Data on patient demographics, operative variables (estimated blood loss, hemoglobin decrease, operation time, perioperative complications, and postoperative hospital stay), and obstetric outcomes (the surgery-to-pregnancy interval and birth-related outcomes) were obtained from medical records and analyzed. The mean age of the patients was 40.6 ± 6.6 years. The patients had had an average of 2.3 ± 2.2 myomas removed; the largest myoma size was 6.8 ± 2.4 cm. The mean operation time, postoperative hemoglobin decrease, and postoperative hospital stay duration were 112.9 ± 45.3 minutes, 1.7 ± 1.1 g/dL, and 2.2 ± 1.4 days, respectively. The overall rate of postoperative complications was 7.7% (39/504), and the common complications were transfusions (16/504, 3.1%) or wound problems (15/504, 3.0%). Conversion to multiport or open myomectomy was required in 0.8% of the cases (4/504). A total of 376 women were of child-bearing age, and 56 attempted to become pregnant after surgery. The mean interval from surgery to pregnancy was 15.6 ± 12.2 months. The obstetric outcomes were pregnancy (42/56, 75.0%), live birth (39/56, 69.6%), and miscarriage (2/56, 3.6%). One pregnant woman was lost to follow-up. The 39 live births predominantly involved full-term delivery (36/39, 92.3%), mostly through cesarean section (36/39, 92.3%). No postpartum complications were reported. The 2 most common obstetric complications were preterm labor (7.6%) and gestational diabetes (5.1%). SPLM seems to be an effective procedure with good operative and postoperative obstetric outcomes for women with myomas who require surgery and may wish to subsequently become pregnant.

SURGICAL AND OBSTETRICAL OUTCOMES OF SINGLE PORT LAPAROSCOPIC MYOMECTOMY: RESULTS OF 502 CASES

Single-port laparoscopic myomectomy (SPLM) has been introduced as an effort to minimize the invasiveness of the surgical method. Previous studies reported comparable surgical and better cosmetic outcomes of SPLM than conventional multi-port laparoscopic myomectomy. However, there have been few studies reported obstetric outcomes of SPLM. This study aims to analyze the surgical and obstetric outcomes of 502 SPLM cases performed for 10 years.

COMPARISON OF SURGICAL OUTCOMES BETWEEN REDUCED-PORT ROBOTIC SURGERY, SINGLE PORT LAPAROSCOPY AND CONVENTIONAL LAPAROSCOPY FOR MYOMECTOMY

To date, few studies have compared the benefits of different surgical modalities for myomectomy. The purpose of this study was to compare the surgical outcomes and postoperative pain scores of reduced-port robotic myomectomy (RPRM) with those of single-port laparoscopic myomectomy (SPLM) and conventional laparoscopic myomectomy (CLM).

Single-port laparoscopic myomectomy in the virgin womb - a retrospective analysis of 31 consecutive cases

Single-port laparoscopic myomectomy in the virgin womb - a retrospective analysis of 31 consecutive cases

Long-term outcomes of single-port laparoscopic myomectomy using a modified suture technique.

ObjectiveTo evaluate the long-term outcomes, including the pregnancy outcome and recurrence rate after single-port laparoscopic myomectomy (LM) using a modified suture technique with a Hem-o-lok clip (Choi's LM) and conventional 4-port LM.MethodsA retrospective study of patients who underwent Choi's LM (n=55) and 4-port LM (n=102) in a single institutional hospital was conducted. Patients with <3 symptomatic myomas sized <10 cm each and operated on by a single surgeon were included. Recurrence was confirmed when a myoma measuring ≥3 cm was detected.ResultsThe patients in both groups had similar demographic characteristics. Single (76.4% vs. 62.7%) and intramural (52.7% vs. 56.9%) tumors were commonly detected in both groups in the mean diameter (6.8±1.5 cm vs. 7.0±1.6 cm; P=0.40). In Choi's LM, 16 patients (29.1%) needed an additional port; those who were nulliparous and/or had a large leiomyoma more frequently required an additional port (P=0.023 and 0.04, respectively). During a median follow-up period of 69 months, 17 patients (7.1% vs. 14.6%) had recurrence. The size of dominant myomas at recurrence was significantly smaller in patients who underwent Choi's LM (3.4±0.7 cm vs. 5.7±2.4 cm; P=0.004). All 13 patients in both groups who successfully conceived had a full-term delivery. No major complications occurred during pregnancy.ConclusionAlthough an additional port was frequently used, the long-term outcomes of patients who experienced recurrence and pregnancy after Choi's LM were acceptable. Considering its usability, Choi's LM is feasible for the treatment of uterine leiomyoma.

Hybrid Robotic Single-Site Myomectomy Using the GelPoint Platform

Background: To overcome the limitations of single-port laparoscopic myomectomy (SP-LM) and robotic single-site myomectomy (RSSM), we designed a new surgical technique, the so-called hybrid RSSM (H-RSSM), by integrating the advantages of both procedures. This study describes the surgical technique of H-RSSM and reports our initial experiences. Materials and Methods: Between February 2018 and September 2018, H-RSSM was performed in 25 women with symptomatic fibroids. During the H-RSSM, the enucleation of the fibroid was carried out using single-port laparoscopy and the uterine defect was repaired using robotic single-site surgery. To assess the feasibility and efficacy of H-RSSM, the results of this study were compared with those of our previous study on SP-LM and its modified surgical technique, so-called single-port laparoscopically assisted transumbilical ultraminilaparotomic myomectomy (SPLA-TUM). Results: The mean operation time, hemoglobin change, return of bowel activity, and length of hospital stay were 69.4 ± 18.2 minutes, 1.2 ± 0.9 g/dL, 37.1 ± 15.5 hours, and 4.0 ± 0.8 days, respectively. There was no conversion to laparotomy or multiport laparoscopy. There were no surgical or wound complications. Comparing with SP-LM and SPLA-TUM, H-RSSM had significantly shorter operation time and return of bowel activity. Conclusion: H-RSSM can reduce operating time and the conversion rate to multiport laparoscopy and can be considered a feasible alternative for selected patients with symptomatic fibroids. However, further studies are needed to clearly demonstrate these benefits.

A systematic review and meta-analysis comparing single port laparoscopic myomectomy with conventional laparoscopic myomectomy

ObjectiveWe systematically evaluated if there are any clinical differences in the safety and feasibility of single port laparoscopic myomectomy when compared to conventional laparoscopic myomectomy. Study DesignA meta-analysis and systematic review was conducted in accordance with the PRISMA statement. We searched different databases including Medline, Embase, Cochrane, and Google Scholar up to April 2018. Comparative studies as randomized controlled trials and prospective and retrospective cohort studies were included. ResultsA meta-analysis was performed on the safety, feasibility, and potential benefits. Two randomized controlled trials and six cohort studies (2 prospective and 4 retrospective) were meta-analyzed to compare the surgical outcomes of 907 patients. Rates of minor complications were not different between the two groups [OR 1.33 (0.67, 2.63), I2 = 0%]. Major complications requiring re-operation occurred in two cases in the single port group and in the conventional group respectively. There was no significant statistical difference between the groups. Conversion to laparotomy did not occur in either group, and the conversion rate from single port to the multi-port operation was 2.1% (6/288). The pain score one hour after operation was significantly lower in the single port group [MD -0.41 point (-0.63, -0.18), I2 = 3.7%]. However, this difference was not observed at six and 24 h postoperatively. There was no difference in the operation time, estimated blood loss, or hemoglobin decrease between the two groups. ConclusionA meta-analysis showed that single port laparoscopic myomectomy is comparable to conventional laparoscopic myomectomy in terms of safety and feasibility and more advantageous in terms of immediate postoperative pain. If performed based on the appropriate patient selection criteria including size and number of myoma, single port laparoscopic myomectomy can have similar surgical outcomes to those of conventional laparoscopic myomectomy. Further research and resources are required to identify whether single port laparoscopic myomectomy is more beneficial in terms of cosmetic results, patient satisfaction, and pregnancy outcomes.

In-bag power morcellation technique in single-port laparoscopic myomectomy.

ObjectiveThis study introduces and evaluates the feasibility, safety, and surgical outcomes of the in-bag power morcellation technique during single-port assisted (SPA) laparoscopic myomectomy in comparison with manual scalpel morcellation.MethodsThis is a retrospective review of a total of 58 patients who underwent SPA laparoscopic myomectomy employing in-bag power morcellation (n=27) or manual scalpel morcellation (n=31), performed between December 2014 and December 2016. Surgical outcomes, including total operation time, estimated blood loss, postoperative hemoglobin changes, postoperative hospital stay, postoperative pain (visual analog scale), perioperative and postoperative complications were evaluated.ResultsThe demographics and patient characteristics were similar between both groups. The median patient age was 34 years and median body mass index was 20.84 kg/m2. The median specimen weight was 110 g. The median operating time was 138 minutes. The median estimated blood loss was 50 mL and the median postoperative hemoglobin change was 2.2 g/dL. The median postoperative hospital stay was 2 days and the median postoperative pain scores were 5 after 6 hours, 3 after 24 hours, and 2 after 48 hours. Occult malignancy was not identified in any patients. There were no intraoperative complications such as LapBag ruptures or gross spillage.ConclusionIn-bag power morcellation for SPA laparoscopic myomectomy is feasible and safe, minimizing the risks of open power morcellation. There were also no statistically significant differences in surgical outcomes.

501 - Single-Port Laparoscopic Myomectomy Using in-Bag Manual Extraction for Huge Uterine Myomas

The aim of this video presentation is to show that even for huge uterine myomas, the transumbilical in-bag manual extraction is feasible and could be a safe alternative to the power morcellation. We present two cases. One is a 38 year-old, gravida 1, para 1 woman with a uterine myoma of 20 × 15 cm in size and the other one is a 35 year-old, gravida 0, para 0 woman with a uterine myoma of 15x13 cm in size. We performed single-port laparoscopic myomectomy through a 1.5- to 2.0-cm umbilical incision. The myomas were cut in the bag with a knife and then extracted. The two patients were discharged from the hospital on the third postoperative day with an uneventful postoperative period. Even for huge uterine myomas, transumbilical in-bag manual extraction with a knife is a feasible and safe alternative to avoid the potential risk of spreading malignancy.

Advantages of Single-Port Laparoscopic Myomectomy Compared with Conventional Laparoscopic Myomectomy: A Randomized Controlled Study

Study ObjectiveTo compare operative outcomes of single-port laparoscopic myomectomy (SP-LM) vs conventional laparoscopic myomectomy (CLM), including subjective and objective cosmetic aspects. DesignProspective randomized controlled trial (Canadian Task Force classification I). SettingUniversity hospital. PatientsWomen with uterine myoma scheduled for laparoscopic myomectomy. InterventionsSixty-six women were assigned at random to either the SP-LM or CLM group. Surgical outcomes, including patient and observer scar assessments, were evaluated between the groups according to the intention-to-treat principle. Measurements and Main ResultsThere were no significant differences in demographic characteristics and properties of myomectomy between the groups. There also were no differences in surgical outcomes, such as operation time, estimated blood loss, and complications, between the 2 groups. The mean total score of the Observer Scar Assessment Scale was lower in the SP-LM group at 1 week (13.0 ± 3.2 vs 18.3 ± 4.8; p < .001) and 8 weeks (9.9 ± 3.2 vs 14.3 ± 3.8; p < .001) after discharge. Similar results were obtained for the Patient Scar Assessment Scale at 1 week (11.6 ± 7.2 vs 18.5 ± 12.8; p = .024) and 8 weeks (9.5 ± 6.0 vs 18.8 ± 9.1; p < .001) after discharge. Postoperative pain and analgesic consumption did not differ between the groups, except in patient-controlled analgesia consumption at 6 hours after operation, which was lower in the SP-LM group (12.7 ± 6.3 mL vs 16.4 ± 6.2 mL; p = .039). Operative outcomes were similar in the 2 groups. ConclusionSP-LM is associated with more favorable cosmetic outcomes and better patient satisfaction compared with CLM. There were no differences in operative outcomes and complications between the 2 modalities.

Comparison study of consecutive 100 cases of single port vs. multiport laparoscopic myomectomy; technical point of view

We report our experience with single-port and multiple-port laparoscopic myomectomy with operative outcomes and surgical skills. Hundred consecutive patients underwent single-port laparoscopic myomectomy (SP-LM) and 69 multi-port laparoscopic myomectomy (MP-LM). The operative outcomes were compared between the two methods. All procedures were successfully completed without conversion to abdominal myomectomy. The mean maximum diameter of the largest myoma was 7.4 (5–13) vs. 6.8 (5–12) cm and the mean number of myomas was 1.7 vs. 1.6 in SP-LM and MP-LM group, respectively. Mean operative time was 134.2 vs. 122.9 min in SP-LM and MP-LM group (p = .109). We showed that SPL myomectomy is a safe and feasible technique compared to MPL myomectomy with respect to postoperative pain, mean operating time, mean estimated blood loss and length of stay. To improve suturing technique of SP-LM, the working instruments were placed external to the telescope with ‘micro-triangulation’.

Single-port laparoscopically assisted-transumbilical ultraminilaparotomic myomectomy (SPLA-TUM) versus single port laparoscopic myomectomy: a randomized controlled trial

ObjectiveTo evaluate whether single-port laparoscopically assisted-transumbilical ultraminilaparotomic myomectomy (SPLA-TUM) has a shorter operating time than single port laparoscopic myomectomy (SP-LM), without negatively affecting postoperative pain and cosmesis. Study designWe performed a randomized controlled trial at a University teaching hospital. A total of 92 premenopausal women with symptomatic, superficial intramural or subserosal fibroids were randomized to receive either SPLA-TUM or SP-LM. The primary outcome measured was the operating time. The secondary outcome measures included postoperative pain, as measured by a visual analog scale (VAS) at 2, 6, 12, 24, and 48h after the operation, and cosmetic outcomes, as measured by the Vancouver scar scale (VSS) and patient satisfaction with the scars, using a VAS at 3 postoperative months. ResultsThere were no differences in the patient demographics or in the clinical characteristics of the resected fibroids between the two groups. The operation results showed no differences in the hemoglobin changes, return of bowel activity, hospital stay, and complication rate between the groups. The mean operating time in the SPLA-TUM group was shorter than that in the SP-LM group (87.0±32.7min compared with 102.3±32.9min, P=0.026). The patients in each group demonstrated no differences in their postoperative pain levels, VSS scores, and satisfaction with the scars, but the SPLA-TUM group had a longer umbilical wound compared with the SP-LM group. Two (4.3%) patients in the SPLA-TUM group received SP-LM. One (2.2%) patient in the SP-LM group and two (4.3%) patients in the SPLA-TUM group were converted to two or three port laparoscopic myomectomy. ConclusionsSPLA-TUM has a shorter operating time than SP-LM due to convenient suturing and knotting; the two procedures have comparable postoperative pain levels and cosmetic outcomes. However, further study is needed to evaluate the long-term outcomes of SPLA-TUM.

Learning Curve Analysis and Surgical Outcomes of Single-port Laparoscopic Myomectomy.

To identify learning curves for single-port laparoscopic myomectomy (SPLM) and evaluate surgical outcomes according to the sequence of operation. A retrospective study. A university-based hospital (Canadian Task Force classification II-2). The medical records from 205 patients who had undergone SPLM from October 2009 to May 2013 were reviewed. Because the myomectomy time was significantly affected by the size and number of myomas removed by SPLM, cases in which 2 or more of the myomas removed were >7 cm in diameter were excluded. Furthermore, cases involving additional operations performed simultaneously (e.g., ovarian or hysteroscopic surgery) were also excluded. A total of 161 cases of SPLM were included. None. We assessed the SPLM learning curve via a graph based on operation time versus sequence of cases. Patients were chronologically arranged according to their surgery dates and were then placed into 1 of 4 groups according to their operation sequence. SPLM was completed successfully in 160 of 161 cases (99.4%). One case was converted to multiport surgery. Basal characteristics of the patients between the 4 groups did not differ. The median operation times for the 4 groups were 112.0, 92.8, 83.7, and 90.0 minutes, respectively. Operation time decreased significantly in the second, third, and fourth groups compared with that in the first group (p < .001). Proficiency, which is the point at which the slope of the learning curve became less steep, was evident after about 45 operations. Results from the current study suggested that proficiency for SPLM was achieved after about 45 operations. Additionally, operation time decreased with experience without an increase in complication rate.