Single-port laparoscopic myomectomy using transumbilical GelPort access

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Abstract

Objective

To describe our initial experience with single-port laparoscopic myomectomy (SP-LM) using transumbilical GelPort access and the surgical technique used, and to evaluate the safety and feasibility of this procedure.

Study design

A prospective observational study was performed at a university teaching hospital from January 2009 to December 2009. Fifteen patients with symptomatic subserosal or superficial intramural myomas (≤8 cm) underwent SP-LM.

Results

The mean age and body mass index were 35.0 ± 8.6 years and 22.6 ± 2.6 kg/m2. Two patients had a history of previous abdominal surgery, consisting of one and two cesarean deliveries. The mean operating time, hemoglobin change, return of bowel activity, and length of hospital stay were 81 ± 21.5 min, 1.1 ± 0.5 g/dL, 34.3 ± 5.9 h, and 3.1 ± 0.5 days, respectively. In one patient (6.7%), SP-LM was converted to two-port LM. There were no surgical or wound complications in any patient, and the histopathological result was leiomyoma in all the cases.

Conclusion

SP-LM is feasible in selected patients with symptomatic myoma.

Introduction

Myomas are the most frequent benign tumors of the uterus and affect approximately 25–40% of women of reproductive age. Laparoscopic myomectomy (LM) is a surgical procedure that has been performed frequently in the gynecological field since its introduction by Semm at the end of the 1970s [1], [2]. Laparoscopic surgery has developed rapidly and is performed commonly because of its benefits, which include shorter hospitalization, faster recovery, fewer adhesions, cosmetic advantages, and reduced blood loss.

Studies of single-port laparoscopic surgery (SP-LS), also known as single-port access, laparoendoscopic single-site surgery, single-incision laparoscopic surgery, and embryonic natural-orifice transumbilical endoscopic surgery, have been actively undertaken. Because SP-LS is expected to improve cosmesis and reduce incisional morbidity relative to those of multiport laparoscopic surgery, early studies of SP-LS have been reported in various areas [3], [4], [5], [6], [7], [8]. At this time, however, there has been no reported study of single-port laparoscopic myomectomy (SP-LM). Therefore, we present our initial experiences with SP-LM and the surgical technique used in selected patients with symptomatic myoma.

Section snippets

Materials and methods

From January 2009 to December 2009, 15 patients undergoing SP-LM were enrolled in this study. The patients were selected consecutively, based on their ultrasonographic characteristics, and the data were collected prospectively.

The inclusion criteria included the presence of a symptomatic myoma measuring 8 cm or less on ultrasonographic examination, and a superficial intramural or subserosal type of myoma. A myoma is defined as a superficial intramural myoma when the distance between it and the

Results

During the study period, 131 women with symptomatic myoma were treated with LM at our institution. Among them, 15 patients who met the inclusion criteria and consented to involvement in this study underwent SP-LM. The detailed patient characteristics and operative results are shown in Table 1. Two patients had a history of previous abdominal surgery, consisting of one and two cesarean deliveries, respectively.

The concomitant procedures included single-port laparoscopic unilateral ovarian

Discussion

Various types of SP-LS have recently been performed in the gynecological field. SP-LS has known advantages, including fewer infections and hernias, shorter hospital stays, improved recovery times, and better cosmetic outcomes. Disadvantages include longer operating times and learning times, and the need for specialized instruments [6], [8].

It has been reported that SP-LS can result in surgical difficulty when attempted with large lesions of over 8 cm, and in invasive surgery [16], [17]. Because

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This article was not supported by any financial funds and the authors are not affiliated with the instrument company referred to in the text.

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