Laparoscopic Single-Site Myomectomy of 11-cm Intramural Myoma.

Journal of minimally invasive gynecology

PubMedID: 26070726

Guan X, Walsh TM, Osial P, Xu D. Laparoscopic Single-Site Myomectomy of 11-cm Intramural Myoma. J Minim Invasive Gynecol. 2015;.
STUDY OBJECTIVE
To demonstrate the feasibility of laparoscopic single-incision myomectomy using new technology.

DESIGN
A step-by-step video demonstrating our technique for accomplishing a laparoscopic single-site myomectomy of a large intramural myoma.

SETTING
Single institution.

INTERVENTIONS
Single-incision laparoscopic surgery (SILS) has been shown to have similar outcomes to multiport laparoscopy but with superior cosmetic results [1,2] but has traditionally been associated with an increased learning curve, primarily because of poor ergonomics and instrument collisions, lack of triangulation, and, until recently, inadequate instrumentation.

MEASUREMENTS AND MAIN RESULTS
We present a case of laparoscopic single-site myomectomy of an 11-cm intramural myoma. This video was exempt from institutional review board review at our institution. SILS has traditionally been associated with poor ergonomics; however, we found that the articulating Enseal G2 Articulating Tissue Sealer (Ethicon Endo-Surgery, Blue Ash, OH) enables completion of complex surgical procedures not traditionally associated with single-site laparoscopy. This video demonstrates our technique to successfully accomplish a single-site laparoscopic myomectomy including the importance of vertical closure with V-Loc (Covidien, New Haven, CT) at the surgical site.

CONCLUSION
We found that the articulating Enseal enables a single-incision laparoscopic myomectomy to be performed with only minimal modifications on multiport surgery techniques. We were able to successfully perform a myomectomy on an 11-cm intramural myoma with excellent cosmetic results.