Haworth Laura A, Siewertsz van Reesema Lauren L, Palin Hannah S, Ofori-Dankwa Zenobia, Woo Jeffrey J, Hudgens Joseph L
Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University (formerly Eastern Virginia Medical School), Norfolk, Virginia (all authors).
Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University (formerly Eastern Virginia Medical School), Norfolk, Virginia (all authors).
J Minim Invasive Gynecol. 2025 Sep;32(9):815-822. doi: 10.1016/j.jmig.2025.05.001. Epub 2025 May 9.
This study presents a novel two-port technique for laparoscopic myomectomy, examining perioperative outcomes from 87 cases DESIGN: Retrospective case series.
Tertiary academic hospital in Norfolk, Virginia.
Patients who underwent two-port laparoscopic myomectomy over a six-year period, performed by a single fellowship-trained surgeon. Cases were identified via current procedural terminology (CPT) codes for laparoscopic myomectomy.
The two-port technique uses a multi-port system at the umbilicus, a 45-degree bariatric laparoscope, and a 5-mm trocar in the right lower quadrant. This method reduces abdominal incisions, improves traction for fibroid removal, enhances triangulation for laparoscopic suturing, and expedites specimen extraction.
Eighty-seven patients were included, with a mean age of 37.5 years (±5.2). The most common fibroid type was FIGO type 2-5. An average of 3.6 fibroids (±3.1) were removed per case. The mean dominant fibroid diameter was 5.2 cm (±2.3), and the mean total fibroid weight removed was 139.8 grams (±114.4). The mean EBL and operative time were 128 mL (±138.9) and 153 minutes (±45.9), respectively. Fibroid number and weight correlated with increasing operative time, while fibroid weight significantly correlated with higher EBL. No conversions to laparotomy occurred. Most patients (74.7%) were discharged on the same day.
Two-port laparoscopic myomectomy is a safe and effective option for a variety of fibroid types, with outcome data comparable to previously reported data on conventional laparoscopic methods. This technique combines the benefits of traditional triangulation with improved cosmesis of single-site surgery, while providing a dedicated specimen extraction site. Candidates for two-port myomectomy are those eligible for a conventional laparoscopic approach; however, challenges may arise with intramural fibroids >10 cm, multiple fibroids (≥4), or need for multiple hysterotomy incisions, requiring careful patient selection and surgeon discretion.
For properly selected patients, a two-port laparoscopic myomectomy technique is safe, effective, and associated with favorable outcomes, including a high same-day discharge rate and minimal complications.
本研究介绍一种用于腹腔镜子宫肌瘤切除术的新型双孔技术，并对87例患者的围手术期结果进行分析。设计：回顾性病例系列研究。
弗吉尼亚州诺福克的三级学术医院。
在六年期间接受单孔腹腔镜子宫肌瘤切除术的患者，由一名经过专科培训的外科医生实施手术。通过腹腔镜子宫肌瘤切除术的当前手术操作术语（CPT）编码识别病例。
双孔技术在脐部使用多通道系统、45度减重腹腔镜和右下腹的5毫米套管针。该方法减少了腹部切口，改善了肌瘤切除的牵引，增强了腹腔镜缝合的三角定位，并加快了标本取出。
纳入87例患者，平均年龄37.5岁（±5.2岁）。最常见的肌瘤类型为国际妇产科联盟（FIGO）2 - 5型。每例平均切除3.6个肌瘤（±3.1个）。优势肌瘤平均直径为5.2厘米（±2.3厘米），切除的肌瘤总平均重量为139.8克（±114.4克）。平均估计失血量（EBL）和手术时间分别为128毫升（±138.9毫升）和153分钟（±45.9分钟）。肌瘤数量和重量与手术时间增加相关，而肌瘤重量与较高的EBL显著相关。无中转开腹情况发生。大多数患者（74.7%）在同一天出院。
双孔腹腔镜子宫肌瘤切除术对于各种肌瘤类型是一种安全有效的选择，其结果数据与先前报道的传统腹腔镜方法的数据相当。该技术结合了传统三角定位的优点和单孔手术更好的美容效果，同时提供了专门的标本取出部位。双孔子宫肌瘤切除术的候选者是那些适合传统腹腔镜手术的患者；然而，对于直径>10厘米的壁间肌瘤、多个肌瘤（≥4个）或需要多个子宫切口的情况可能会出现挑战，需要仔细选择患者并由外科医生酌情决定。
对于选择合适的患者，双孔腹腔镜子宫肌瘤切除术技术安全、有效，且具有良好的结果，包括高当日出院率和最少的并发症。
