Single-port laparoscopic myomectomy using a new single-port transumbilical morcellation system: initial clinical study.
OBJECTIVE
To evaluate the feasibility of single-port laparoscopic myomectomy with transumbilical morcellation and suturing.


METHODS
Continuing prospective study (Canadian Task Force classification II-3).


METHODS
University hospital.


METHODS
Fifteen patients who underwent single-port laparoscopic myomectomy between September 2008 and October 2009 to remove single or multiple uterine myomas, at least 1 in each patient measuring greater than 4 cm in diameter.


METHODS
All single-port laparoscopic myomectomy procedures were performed by a single surgeon (Dr. Y.W. Kim). Myomas were extracted transumbilically by cutting the myomas into smaller pieces with a knife or a conventional electromechanical morcellator. After making a single 1.5- to 2.0-cm umbilical incision, the single-port system, created with a wound retractor and a surgical glove, was inserted. All operations were performed using conventional rigid straight laparoscopic instruments. Laparoscopic suturing was performed in intramural myomas and some subserosal myomas.


RESULTS
Patient mean (SD; range) age was 38.3 (5.6; 29-49) years. The number of myomas per patient was 1.6 (1.4; 1-6). The diameter of the largest myomas was 6.1 (1.5; 4.2-9.6) cm. In 4 patients, only a knife was required for transumbilical extraction of myomas, and in 11 patients, transumbilical morcellation with an electromechanical morcellator with or without a knife was used. Transumbilical drainage tubes were inserted into the pelvic cavity in 11 of 15 patients. Operative time was 96.7 (33.8; 35-150) minutes. The decrease in postoperative hemoglobin concentration was 1.8 (1.2; 0.4-3.6) g/dL. During the operations, no patients required blood transfusion. No patients developed postoperative fever. Neither bowel injury nor urinary tract injury occurred in any patient. The postoperative hospital stay was 3.1 (0.8; 2-4) days.


CONCLUSIONS
Single-port transumbilical morcellation using a conventional electromechanical morcellator with or without a knife is feasible. Single-port laparoscopic myomectomy is an alternative method with cosmetic advantage.
Kim
Yong-Wook
YW
Department of Obstetrics and Gynecology, College of Medicine, Catholic University of Korea, Incheon St. Mary's Hospital, Bupyeong-gu, Incheon, Korea. ywk@catholic.ac.kr
Park
Byung-Joon
BJ
Ro
Duck-Yeong
DY
Kim
Tae-Eung
TE
D000328:Adult; D005260:Female; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D018231:Leiomyomatosis / Q000601:surgery*; D011446:Prospective Studies; D013536:Suture Techniques; D014594:Uterine Neoplasms / Q000601:surgery*