Isobaric two-port laparoscopic-assisted myomectomy by combined approach through umbilical and suprapubic mini-incisions with hidden scar: a technique and initial experience.
OBJECTIVE
To report our initial experience with isobaric (gasless) two-port laparoscopic-assisted myomectomy (LAM) in 40 patients with symptomatic myoma at a single center.


METHODS
In each case, wound retractors were used as working ports through umbilical and suprapubic mini-incisions. The surgical view was secured with the subcutaneous abdominal wall-lift method. Surgical procedures were performed using conventional laparoscopic and laparotomic instruments under vision with a rigid 30-degree, 5-mm EndoEYE laparoscope. Clinical data regarding patient demographics and surgical outcomes were retrospectively analyzed.


RESULTS
Between November 2010 and May 2011, forty patients with symptomatic myomas were treated with isobaric two-port LAM. Cases consisted of 24 intramural, 13 subserosal and 3 submucosal myomas in various locations. The median surgical duration was 86 (range, 38-160)min with median blood loss of 50 (range, 10-670)mL. Median number and weight of excised myoma nodes were 2.5 (range, 1-30) and 130.5 (range, 4-712)g, respectively. Neither additional incisions nor laparotomic conversion were required in any cases. Although major surgical complications were not experienced in the present case series, extended hospitalization was required in 4 cases (10%) due to elevated inflammatory parameters. Delayed dehiscence of the suprapubic incision was noted in 1 case and was conservatively managed. After the umbilical incision was concealed within the umbilical fold and the suprapubic incision was hidden in the pubic hair, all patients were satisfied with their cosmetic results.


CONCLUSIONS
Isobaric two-port LAM performed by a combined approach through umbilical and suprapubic mini-incisions with hidden scar is a useful minimally invasive measure for management of symptomatic uterine myomas under various conditions.
Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-cho, Tajimi, Gifu 507-8522, Japan. gyendoscopy@gmail.com
Akihiro
A
Takeda
Sanae
S
Imoto
Masahiko
M
Mori
Junko
J
Yamada
Hiromi
H
Nakamura
D000328:Adult; D002921:Cicatrix / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D014472:Umbilicus / Q000601:surgery; D014594:Uterine Neoplasms / Q000601:surgery*