Transumbilical laparoendoscopic single-site surgery versus conventional multi-port laparoscopy for myomectomy: A large single-center retrospective study.

INTRODUCTION

Uterine leiomyomata are the most common neoplasms among women of reproductive age. Laparoscopic myomectomy is desirable for patients who wish to preserve their fertility or retain their uterus. There lacks a large-scale study to compare the surgical safety between transumbilical laparoendoscopic single-site surgery (single-site laparoscopy) and conventional multi-port laparoscopy.

MATERIAL AND

METHODS

This registered retrospective observational study (MR-51-23-020457, ChiCTR) included patients with leiomyomata who underwent single-site laparoscopy or multi-port laparoscopy for myomectomy. The patients' characteristics, perioperative outcomes, obstetric outcomes, and satisfaction scores for the incision were recorded and analyzed between the two groups. The primary outcome was the incidence of intraoperative adverse events, including organ injury and bleeding, and the secondary outcomes were Enhanced Recovery After Surgery indicators, including surgery-related pain, flatulence time, postoperative hospital stay, and cosmetic satisfaction of incisions.

RESULTS

A total of 1437 single-site laparoscopy and 2514 multi-port laparoscopy patients were included. The incidence of Grade I intraoperative adverse events (organ injury) was 0.70% in single-site laparoscopy and 0.44% in multi-port laparoscopy (p = 0.624), the Grade II intraoperative adverse events (bleeding requiring blood transfusion) were 6.75% in single-site laparoscopy and 6.24% in multi-port laparoscopy (p = 0.533). Single-site laparoscopy patients had shorter postoperative hospital stay (2.21 ± 1.18 vs. 2.70 ± 1.37, p < 0.001) and lower surgery-related pain score (2.82 ± 0.58 vs. 2.89 ± 0.63, p < 0.001). Besides, patients from single-site laparoscopy had a higher satisfaction score for incisional healing (4.60 ± 0.62 vs. 4.43 ± 0.66, p < 0.001) than those from the multi-port laparoscopy group. Additionally, seven single-site laparoscopy patients and nine multi-port laparoscopy patients were diagnosed with uterine sarcoma. During the second surgery, the isolated and minor pelvic implantation found in one patient (0.5 × 0.5 cm) from the single-site laparoscopy group had a smaller size and narrower distribution than that found in the three patients (1.0 × 1.0 cm, 3.0 × 3.0 cm,3.0 × 3.0 cm) from the multi-port laparoscopy group.

CONCLUSIONS

These findings support the notion that single-site laparoscopy and multi-port laparoscopy for myomectomy show similar performance in terms of surgical safety. Single-site laparoscopy outperforms multi-port laparoscopy with respect to postoperative hospital stays and cosmetic satisfaction with the incision.