Uterine Suspension With Adjustable Sutures for Difficult Laparoscopic Myomectomy.
To assess whether transabdominal uterine suspension with adjustable sutures (USAS) is beneficial when performed concomitantly with laparoscopic myomectomy in patients with unfavorably localized leiomyomas in whom uterine manipulators are not an option.



A retrospective cohort study (Canadian Task Force classification II-2).



A university teaching hospital.



Patients (N = 158) with posterior deep intramural, intraligamental, or cervical leiomyomas; 81 patients underwent USAS (suspension group), and 77 patients did not (control group) concomitantly with laparoscopic myomectomy.



Transabdominal USAS was performed for all eligible patients undergoing laparoscopic myomectomy using a 2-0 synthetic, monofilament, nonabsorbable polypropylene suture. One end of the double-headed straight needles of the polypropylene suture was inserted into the pelvic cavity through the abdomen to "lift" or "retract" the uterus to allow for the main tumor to be completely exposed and excised.



The average time to create USAS was 2.5 minutes. For the suspension and control groups, the average number of abdominal ports was 3 and 4.4 (p < .001), the average blood loss was 96.3 and 201.5 mL (p < .001), and the average operative time was 50.8 and 91.2 minutes (p < .001), respectively. There was no significant difference in complications (4.9% vs 9.1%, p = .303), but there was a significant difference in conversion to laparotomy (1.2% vs 10.4%, p = .009). At the 3-year follow-up, there were no significant differences in gynecologic and reproductive outcomes, including leiomyoma recurrence, uterine rupture, and pregnancy and live birth rates. The ratio of conversion to laparotomy (odds ratio = 0.108; 95% confidence interval, 0.013-0.884) was much lower in the suspension group.



USAS is an easy, safe, and feasible alternative to uterine manipulation when performed concomitantly with laparoscopic myomectomy for unfavorably localized uterine leiomyomas.
Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei, Taiwan; School of Medicine, Tzu-Chi University, Hualien, Taiwan. Electronic address: alexgfctw@yahoo.com.tw.
Kuo-Hu
KH
Chen
Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan.
Kok-Min
KM
Seow
Mackay Memorial Hospital, Taipei, Taiwan; Department of Mechanical Engineering, National Chiao-Tung University, Hsinchu, Taiwan.
Li-Ru
LR
Chen
D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery; D000069451:Long Term Adverse Effects / Q000453:epidemiology / Q000209:etiology; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D060728:Reproductive Health; D012189:Retrospective Studies; D013536:Suture Techniques; D013624:Taiwan / Q000453:epidemiology; D063186:Uterine Myomectomy / Q000009:adverse effects / Q000379:methods; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery
Fibroid; Laparoscopic myomectomy; Uterine leiomyoma; Uterine suspension with adjustable sutures