Single port laparoscopic myomectomy with intracorporeal suture-tying and transumbilical morcellation

ObjectiveTo evaluate the feasibility of single-port laparoscopic myomectomy (SPLM) with intracoporeal suture-tying and transumbilical morcellation.Study designWe retrospectively reviewed the medical records of 100 consecutive women who underwent SPLM without any combined surgery between January 2010 and July 2011. The medical records were reviewed and the clinical outcomes were analyzed. Single port entry was established using a wound retractor and a surgical glove. After myoma was enucleated from myometrium, intracorporeal suturing and knot tying was done for myometrium repair. Enucleated myoma was extracted through umbilicus using tissue morcellator. Factors investigated included operation time, blood loss, postoperative hospital stay and complications.ResultsMean patient age and BMI were 40.4 ± 7.1 years and 23.1 ± 3.5 kg/m2. Mean diameter of largest myoma and number of myomas were 6.6 ± 2.2 (range 2-12) cm and 1.6 ± 1.2 (range 1-7), respectively. Mean weight of myoma was 136.9 ± 118.4 (range 4-684) g. Type of the main myomas were intramural (80/100), submucosal (5/100), subserosal (12/100), and intraligamentary (3/100). Location of the main myomas were anterior (36/100), posterior (24/100), fundal (30/100), and lateral (10/100). Mean operation time and estimated blood loss were 116.3 ± 36.8 min and 94.6 ± 74.5 mL. Mean hospital stay after the operation was 2 ± 0.4 days. Conversion to double port surgery (one more trocar inserted on suprapubic site) was occurred in 1 patient due to severe pelvic adhesion. No patient experienced major complications, including bowel, ureter, or bladder injuries, or incisional hernia.ConclusionSPLM is safe and acceptable for various myoma sites and sizes up to 12 cm. Intracorporeal suture-tying and transumbilical morcellation are key technical points of SPLM.