Operative and Obstetric Outcomes after Single-port Laparoscopic Myomectomy: A Retrospective Single-center Analysis of 504 Cases

Abstract

To analyze the obstetric and operative outcomes of 504 cases of single-port laparoscopic myomectomy (SPLM). Design: Single-center retrospective study. Setting: A tertiary university hospital. Patients: A total of 502 patients (504 SPLM procedures) who underwent SPLM for symptom relief or growing myomas between October 2009 and April 2020. Interventions: Data on patient demographics, operative variables (estimated blood loss, hemoglobin decrease, operation time, perioperative complications, and postoperative hospital stay), and obstetric outcomes (the surgery-to-pregnancy interval and birth-related outcomes) were obtained from medical records and analyzed. Measurements and Main Results: The mean age of the patients was 40.6 § 6.6 years. The patients had had an average of 2.3 § 2.2 myomas removed; the largest myoma size was 6.8 § 2.4 cm. The mean operation time, postoperative hemoglobin decrease, and postoperative hospital stay duration were 112.9 § 45.3 minutes, 1.7 § 1.1 g/dL, and 2.2 § 1.4 days, respectively. The overall rate of postoperative complications was 7.7% (39/504), and the common complications were transfusions (16/504, 3.1%) or wound problems (15/504, 3.0%). Conversion to multiport or open myomectomy was required in 0.8% of the cases (4/504). A total of 376 women were of child-bearing age, and 56 attempted to become pregnant after surgery. The mean interval from surgery to pregnancy was 15.6 § 12.2 months. The obstetric outcomes were pregnancy (42/56, 75.0%), live birth (39/56, 69.6%), and miscarriage (2/56, 3.6%). One pregnant woman was lost to follow-up. The 39 live births predominantly involved full-term delivery (36/39, 92.3%), mostly through cesarean section (36/39, 92.3%). No postpartum complications were reported. The 2 most common obstetric complications were preterm labor (7.6%) and gestational diabetes (5.1%). Conclusion: SPLM seems to be an effective procedure with good operative and postoperative obstetric outcomes for women with myomas who require surgery and may wish to subsequently become pregnant.

Learning curve of trans‐areola single‐site endoscopic thyroidectomy in a high‐volume center: A CUSUM‐based assessment

“…Several endoscopic techniques, including single‐site approach, have been proposed that could be potential minimally invasive substitute for open thyroidectomy 2,7,13,31 . With continuous understanding and mastery of single‐site approach technique, its application is increasingly extended in the field of minimally invasive surgery, such as in lung cancer surgery, colon cancer surgery, and gynecological surgery 32–40 . The anatomy of chest wall is different from that of abdominal cavity, which means less trocar intubations consequently lead to less collateral injuries.…”

“… 2 , 7 , 13 , 31 With continuous understanding and mastery of single‐site approach technique, its application is increasingly extended in the field of minimally invasive surgery, such as in lung cancer surgery, colon cancer surgery, and gynecological surgery. 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 The anatomy of chest wall is different from that of abdominal cavity, which means less trocar intubations consequently lead to less collateral injuries. Therefore, the major advantage of trans‐areola single‐site approach is to minimize the surgical burden from multiple‐site approaches, in addition to invisible neck scars.…”

The Impact of Laparoscopic Myomectomy on Pregnancy Outcomes: A Systematic Review

“…The mean age of women across these studies ranged broadly from around 30 to 40 years, with most studies reporting a mean age in the early to mid-thirties, signifying a crucial overlap with both the peak reproductive years and the prevalent age range for myoma development (Table 2). For instance, Yu-cui Tian's study in 2014 [13] had an average age of 30.28 ± 3.99, while Yeon Hee Hong's 2021 study [22] reported a higher average age of 40.6 ± 6.6. This variation in age is crucial as it potentially impacts fertility outcomes post-myomectomy.…”

“…Among these live births, 36 (92.3%) were term deliveries with an average gestational age of 38.2 ± 0.9 weeks, while the remaining 3 (7.7%) were premature deliveries, with an average gestational age of 34.0 ± 3.5 weeks. Cesarean section was the predominant mode of delivery, accounting for 36 infants (92.3%), although 3 infants (7.7%) were delivered vaginally [22].…”

Surgical and Fertility Outcomes of Reduced-Port Robotic Myomectomy: A Single-Center Experience of 401 Cases

“…Compared to laparotomy, laparoscopic myomectomy has the benefits of less blood loss during the operation, shorter hospital stays, less scarring, and faster recovery [ 4 , 5 ]. Our group also has reported good surgical and fertility outcomes following single-port myomectomy [ 6 ]. However, no single surgical approach seems superior to others regarding the fertility rate, as available literature presents conflicting results [ 7 ].…”