title: Laparoscopic Single-Site Myomectomy of 11-cm Intramural Myoma.
abstract: OBJECTIVE
  To demonstrate the feasibility of laparoscopic single-incision myomectomy using new technology.
  
  
  METHODS
  A step-by-step video demonstrating our technique for accomplishing a laparoscopic single-site myomectomy of a large intramural myoma.
  
  
  METHODS
  Single institution.
  
  
  METHODS
  Single-incision laparoscopic surgery (SILS) has been shown to have similar outcomes to multiport laparoscopy but with superior cosmetic results [1,2] but has traditionally been associated with an increased learning curve, primarily because of poor ergonomics and instrument collisions, lack of triangulation, and, until recently, inadequate instrumentation.
  
  
  RESULTS
  We present a case of laparoscopic single-site myomectomy of an 11-cm intramural myoma. This video was exempt from institutional review board review at our institution. SILS has traditionally been associated with poor ergonomics; however, we found that the articulating Enseal G2 Articulating Tissue Sealer (Ethicon Endo-Surgery, Blue Ash, OH) enables completion of complex surgical procedures not traditionally associated with single-site laparoscopy. This video demonstrates our technique to successfully accomplish a single-site laparoscopic myomectomy including the importance of vertical closure with V-Loc (Covidien, New Haven, CT) at the surgical site.
  
  
  CONCLUSIONS
  We found that the articulating Enseal enables a single-incision laparoscopic myomectomy to be performed with only minimal modifications on multiport surgery techniques. We were able to successfully perform a myomectomy on an 11-cm intramural myoma with excellent cosmetic results.
authors.affiliation: Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas. Electronic address: xiaoming@bcm.edu.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Guan
authors.affiliation: Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Walsh
authors.affiliation: Department of Obstetrics & Gynecology, Jersey Shore University Medical Center, Neptune City, New Jersey.
authors.forename: Paulina
authors.initials: P
authors.lastname: Osial
authors.affiliation: Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas.
authors.forename: Dabao
authors.initials: D
authors.lastname: Xu
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007889:Leiomyoma / Q000601:surgery*; D063186:Uterine Myomectomy / Q000379:methods*; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: Abnormal uterine bleeding; Laparoscopic myomectomy; Laparoscopy; Myomectomy; SILS; Single-incision laparoscopy; Single-site laparoscopy; Symptomatic myoma