Obstet Gynecol Sci.  2020 Mar;63(2):164-172. 10.5468/ogs.2020.63.2.164.

Long-term outcomes of single-port laparoscopic myomectomy using a modified suture technique

Affiliations
  • 1Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. chelhun.choi@samsung.com
  • 2Department of Obstetrics and Gynecology, Dankook University Hospital, Cheonan, Korea.

Abstract


OBJECTIVE
To evaluate the long-term outcomes, including the pregnancy outcome and recurrence rate after single-port laparoscopic myomectomy (LM) using a modified suture technique with a Hem-o-lok clip (Choi's LM) and conventional 4-port LM.
METHODS
A retrospective study of patients who underwent Choi's LM (n=55) and 4-port LM (n=102) in a single institutional hospital was conducted. Patients with <3 symptomatic myomas sized <10 cm each and operated on by a single surgeon were included. Recurrence was confirmed when a myoma measuring ≥3 cm was detected.
RESULTS
The patients in both groups had similar demographic characteristics. Single (76.4% vs. 62.7%) and intramural (52.7% vs. 56.9%) tumors were commonly detected in both groups in the mean diameter (6.8±1.5 cm vs. 7.0±1.6 cm; P=0.40). In Choi's LM, 16 patients (29.1%) needed an additional port; those who were nulliparous and/or had a large leiomyoma more frequently required an additional port (P=0.023 and 0.04, respectively). During a median follow-up period of 69 months, 17 patients (7.1% vs. 14.6%) had recurrence. The size of dominant myomas at recurrence was significantly smaller in patients who underwent Choi's LM (3.4±0.7 cm vs. 5.7±2.4 cm; P=0.004). All 13 patients in both groups who successfully conceived had a full-term delivery. No major complications occurred during pregnancy.
CONCLUSION
Although an additional port was frequently used, the long-term outcomes of patients who experienced recurrence and pregnancy after Choi's LM were acceptable. Considering its usability, Choi's LM is feasible for the treatment of uterine leiomyoma.

Keyword

Laparoscopic myomectomy; Modified suture technique; Pregnancy; Single port; Uterine leiomyoma

MeSH Terms

Female
Follow-Up Studies
Humans
Leiomyoma
Myoma
Pregnancy
Pregnancy Outcome
Recurrence
Retrospective Studies
Suture Techniques*
Sutures*

Figure

  • Fig. 1 Single-port laparoscopic myomectomy (LM) with a modified suture technique with a Hem-o-lok clip (Choi's LM). (A) The 1-0 Vicryl suture was tied with a Hem-o-lok clip, which acts as an anchor on the tail of the continuous suture that is the starting point of the suture site. (B, C) A horizontal mattress suture with a deep and wide bite was performed at the bottom of the defect to attach the myometrium closely. (D) A baseball suture was performed in the opposite direction to approximate the myometrium and serosa tightly, while the grasper was used and pushed with maximal tension to cinch down on the last suture site to secure the suture. (E) The same procedures were continuously repeated. (F) The Hem-o-lok clip was used to cinch down on the suture site and secure the knot tightly.

  • Fig. 2 Kaplan-Meier curve showing similar cumulative recurrence rate (P=0.835). Probability of 5-year recurrence-free survival of patients: Choi's LM (82.2%) vs. 4-port LM (86.0%).SP, single-port; LM, laparoscopic myomectomy.


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