Ito Hiroe, Sagawa Yasukazu, Nakagawa Junko, Akaeda Tomoyoshi, Tsutsumi Kiyoaki, Isaka Keiichi
Department of Obstetrics and Gynecology, Tokyo Medical University Hospital, 6-7-1, Nishishinjuku, Shinjukuku, Tokyo, 160-0023, Japan.
Department of Obstetrics and Gynecology, Meirikai Tokyo Yamato Hospital, Tokyo, Japan.
Arch Gynecol Obstet. 2025 Feb;311(2):375-383. doi: 10.1007/s00404-024-07706-9. Epub 2024 Sep 9.
To evaluate the usefulness of gasless reduced-port laparoscopic myomectomy (GRP-LM) using a subcutaneous abdominal wall lifting method.
In GRP-LM, after lifting the abdominal wall by a subcutaneous abdominal wall lifting method, a 1.5-cm incision is made in the lateral abdomen, Lap Protector is placed. The operation is performed by two surgeons, one who inserts multiple forceps from the Lap Protector and performs the operation, and an assistant who operates the laparoscope and uterine manipulator. The surgical outcome of GRP-LM and the factors that affect it were investigated.
GRP-LM was performed in 966 patients. Complications (0.5%) and blood transfusions (0.3%) were remarkably rare, and there were no cases of conversion to open surgery. With regard to the correlation between the number of fibroids extracted and each factor, the number of fibroids extracted correlated with fibroid weight and operation time, but not with blood loss. The average number of sutures per case was 21, and the average suture and ligation time per suture was 77 s. Comparing the cost of GRP-LM with that of the conventional insufflation LM, a saving of $875 was possible with GRP-LM.
GRP-LM is a suitable for multiple fibroids, and is cosmetic and economical, because it allows rapid and reliable suture and ligation, despite having only one port for the procedure.
评估采用皮下腹壁提拉法的免气腹减少端口腹腔镜子宫肌瘤切除术（GRP-LM）的实用性。
在GRP-LM中，通过皮下腹壁提拉法提起腹壁后，在侧腹部做一个1.5厘米的切口，放置腹腔镜保护器。手术由两名外科医生进行，一名从腹腔镜保护器插入多把钳子进行手术，另一名助手操作腹腔镜和子宫操纵器。研究了GRP-LM的手术结果及其影响因素。
966例患者接受了GRP-LM手术。并发症（0.5%）和输血（0.3%）非常罕见，没有转为开放手术的病例。关于取出的肌瘤数量与各因素之间的相关性，取出的肌瘤数量与肌瘤重量和手术时间相关，但与失血量无关。每例平均缝合数为21针，每针平均缝合和结扎时间为77秒。将GRP-LM的成本与传统气腹腹腔镜子宫肌瘤切除术的成本进行比较，GRP-LM可节省875美元。
GRP-LM适用于多发性肌瘤，具有美容和经济的特点，因为尽管该手术仅一个端口，但它能实现快速可靠的缝合和结扎。
