European Journal of Obstetrics & Gynecology and Reproductive Biology
Single-port laparoscopically assisted-transumbilical ultraminilaparotomic myomectomy (SPLA-TUM) versus single port laparoscopic myomectomy: a randomized controlled trial
Introduction
Since single-port laparoscopic myomectomy (SP-LM) was first introduced [1], [2], various studies of this procedure have been published [3], [4], [5], [6], [7]. However, compared with the extensive research on single port laparoscopic surgeries in other gynecologic fields, studies of SP-LM are sparse. This discrepancy might be because of the distinct characteristics of myomectomy, which has excision and suturing unlike those in other (mainly destructive) surgeries. Furthermore, single-port laparoscopic surgery (SP-LS) is difficult to apply in myomectomy because it is inevitably accompanied by technical difficulties, particularly in laparoscopic suturing and knotting.
To overcome the technical disadvantages of SP-LM, the authors developed a new surgical technique called ‘Single-port Laparoscopically Assisted-transumbilical Ultraminilaparotomic Myomectomy (SPLA-TUM)’ by integrating the advantages of both single-port laparoscopy and minilaparotomy [8]. The authors hypothesized that SPLA-TUM might shorten the operating time while maintaining the feasibility, safety, and advantages of single-port laparoscopy. In this study, we evaluated whether SPLA-TUM has a shorter operating time than SP-LM.
Section snippets
Study design
This prospective, randomized, controlled trial was performed at a university teaching hospital from July 2012 to November 2013. The study protocol was approved by the institutional review board at our hospital.
Participants
All premenopausal women (older than 18 years old) scheduled for SP-LM were enrolled. The indications of SP-LM are women with symptomatic, superficial intramural or subserosal type of fibroid on ultrasonographic examination and with a uterus ≤16 weeks gestational size on pelvic examination
Results
During the study period, 116 women were assessed for eligibility; 92 of these women fulfilled both the inclusion and exclusion criteria and were randomly assigned to SPLA-TUM or SP-LM group (46 women in each group) (Fig. 1).
There were no statistically significant between-group differences in the demographics of the participants or in the clinical characteristics of the resected fibroids (Table 1, Table 2).
In terms of operative results, there were no significant differences in the hemoglobin
Comment
In our previous report on the surgical technique and initial experience of SPLA-TUM, we proposed that SPLA-TUM theoretically has several advantages provided by single-port laparoscopy and ultraminilaparotomy [8]. In aspect of single-port laparoscopy, the advantages are (1) favorable cosmetic outcomes and (2) greater applicability, as well as minimizing surgical injuries to the tubes or uterus by better understanding of the anatomical relationship compared with minilaparotomy. On the other hand,
Conflict of interest statement
This article was not supported by any financial funds and not affiliated with the instrumental company referred to in the text.
Condensation
Compared with single port laparoscopic myomectomy, single-port laparoscopically assisted-transumbilical ultraminilaparotomic myomectomy (SPLA-TUM) can shorten surgical times, with comparable postoperative pain and cosmetic outcomes.
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2022, Journal of the Formosan Medical AssociationCitation Excerpt :The surgeon can manage cervical myoma or posterior wall myoma smoothly with favorable surgical outcomes via LETS-M. The diameter and weight of myomas in our study were larger than those in most previous reports, either with multiport (mean diameter ranging from 5.9 to 6.5 cm, mean weight ranging from 126.8 to 195.9 g)15,17,21,22,25 or single-port settings (mean diameter ranging from 5.4 to 7.5 cm, mean weight ranging from 131 to 173.9 g).12–15,17,18,22,25,26 The operation time was relatively short (mean 82.4 to 140 minutes in the multiport setting and 115.6 to 196.5 minutes in the single-port setting).
Robotic single-port surgery using the da Vinci SP® surgical system for benign gynecologic disease: A preliminary report
2020, Taiwanese Journal of Obstetrics and GynecologyCitation Excerpt :Single-port laparoscopic surgery (SPLS) represents a technological attempt to further enhance cosmetic benefits and reduce morbidity and pain with the development of minimal invasive surgical techniques [1]. However, SPLS still has some limitations in women with deep seated myoma or advanced endometriosis [2]. Especially, loss of triangulation, instrument crowding and clashing, poor visualization, and ergonomic difficulty are the most challenging issues associated with SPLS.
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2017, Gynecology and Minimally Invasive TherapyCitation Excerpt :Additionally, the Food and Drug Administration (20140417) stated that intracorporeal morcellation can inadvertently spread cancerous tissue beyond the uterus and into other parts of the body.2,3 After this warning from the Food and Drug Administration, several myoma retrieval procedures were reported, such as in-bag morcellation,4,5 transvaginal extraction,6 transumbilical extraction,7–11 and lower abdominal incision.12 Before this warning, a power morcellator was commonly used in our institution.
Laparoendoscopic single-site myomectomy using conventional laparoscopic instruments and glove port technique: Four years experience in 109 cases
2017, Taiwanese Journal of Obstetrics and GynecologyCitation Excerpt :A few articles describing the LESS-M technique were published in the late 2010s [7,8]. The small number of published studies seems to be related to the technical difficulty of suturing and tying while performing LESS-M, thereby limiting its wide application [9–14]. However, these studies showed the feasibility and safety of LESS-M with small case series.
Surgical treatment: Myomectomy and hysterectomy; Endoscopy: A major advancement
2016, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :Learning curve was not associated with more complication, postoperative hemoglobin drop loss, fever, and length of hospital. Because of technical difficulties of single-port laparoscopic myomectomy, particularly in laparoscopic suturing and knotting, teams have developed alternative techniques called “single-port laparoscopy-assisted transumbilical ultraminilaparotomic myomectomy” [15]. This technique, which combined the advantage of mini-invasive laparoscopic dissection and the rapidity of suturing and knotting during ultraminilaparoscopy, allowed shorter operative time without less postoperative pain.