Surgical Outcome of Two-port Laparoscopic Myomectomy
Condition: Uterine Myoma
MeSH terms: Leiomyoma; Myofibroma
Study type: Observational

Summary: 
      Study Objective: To evaluate the surgical outcome of laparoendoscopic two-sites myomectomy
      (LETS-M) and compare the difference between an experienced surgeon and three trainees.

      Design: A retrospective study. Setting: A university hospital and a tertiary care center.
      Patients: 204 women underwent LETS-M
    

Detailed description: 
      Laparoscopic myomectomy (LM) is an alternative and advanced technique that can take the place
      of traditional open surgery and achieve the goal of minimally invasive operation for women
      who wish to preserve the uterus. However, LM is considered a time-consuming procedure,
      requiring more suturing and knot-tying, and is better performed for woman with an appropriate
      uterine size by experienced surgeons.

      Laparoendoscopic two-sites myomectomy (LETS-M) is a novel setting for LM on a two-port basis,
      using the umbilical glove port, three trocars, and conventional laparoscopic equipment.

      Between January 2015 and September 2019, the medical records of women with uterine myoma
      managed by LETS-M were retrospectively reviewed.

      The review of the chart records consisted of a detailed history, such as age, body mass index
      (BMI), gravidity, parity, marital status, sexual experience, previous abdominal surgery, and
      hospital stay after the surgery. All women received preoperative ultrasound for their uterine
      myoma assessment, including the location, type, size, number, and accompanying pathology,
      such as an ovarian tumor. The myoma locations were identified during the operation and
      classified into fundal wall myoma, anterior wall myoma, posterior wall myoma, and cervical
      myoma. The myoma type classification was based on the International Federation of Gynecology
      and Obstetrics (FIGO) leiomyoma subclassification system. We measured the weight of the
      specimen after finishing the surgery. The operation time was defined as the period from the
      incision to the closure of the skin. Any intraoperative blood loss less than 50mL or minimal
      blood loss on operation note was recorded as 50 milliliters in this study. Excessive blood
      loss was defined as more or equal to 500 milliliters in the operation. The postoperative pain
      scale was evaluated by a visual analog scale (VAS) on the first and second postoperative
      days.
    

Intervention name(s): LETS-M
Intervention type(s): Procedure
Intervention description(s): A 1.5-centimeter skin incision was made over the umbilicus, and the abdominal wall was opened layer by layer with an open method. A wound retractor (Alexis, 2-4 centimeter; Applied Medical Resources Corp., Rancho Santa Margarita, CA) was placed, and the glove port was set up, with a 10-millimeter trocar in the thumb over patient's right side, and a 5-millimeter trocar in the little finger over the left side. The pneumoperitoneum was established. A 10-millimeter rigid laparoscope was inserted via the 10-millimeter trocar and controlled by the assistant. The ancillary 5-millimeter port was made over the left lower abdomen under laparoscope inspection. The surgeon performed the surgery via the two 5-millimeter trocars.
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Women who were older than 20 years old and had not reached menopause, with symptomatic
        uterine myomas, such as hypermenorrhea, infertility, a mass effect-related urinary
        frequency and constipation, received LETS-M for their uterine myoma.
      
Keywords: Laparoscopy; Two-port