Single-Port Laparoscopic Myomectomy Using a New Single-Port Transumbilical Morcellation System: Initial Clinical Study

Abstract 

Study Objective

To evaluate the feasibility of single-port laparoscopic myomectomy with transumbilical morcellation and suturing.

Design

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

Setting

University hospital.

Patients

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.

Interventions

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.

Measurements and Main 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.

Conclusion

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.

Keywords: Laparoscopic myomectomy, Single port, Transumbilical morcellation, Uterine myoma