Application of transumbilical paring and retrieving techniques in laparoscopic myomectomy

To investigate the safety and effectiveness of transumbilical paring and retrieving techniques (TPRT) in conventional laparoscopic surgery (CLS). From July 2020 to October 2021, TPRT, based on transumbilical laparoendoscopic single-site surgery (TU-LESS), was applied to 111 cases of conventional laparoscopic myomectomy. The operation procedures included routine conventional laparoscopic myomectomy and uterine suture, placement of the endoscopic bag, tumor bagging, umbilical incision, paring and retrieving the tumor, and repairing the umbilical incision. Under direct vision, the tumor in the specimen bag was removed by clamping, pulling and reducing through the umbilical incision. All operations were successfully completed. The average number of leiomyomas removed was 1.94 (range, 1–11), and the mean tumor weight was 155.45 g (range, 40–665 g). The mean total tumor removal time, from endoscopic bag placement to umbilical incision repair, was 12.60 min (range, 6–28 min). The mean visual analog scale (VAS) scores evaluated on postoperatively day 1 was 2.59 (range, 1–4). Most of the removed lesions were diagnosed as benign leiomyoma on postoperative pathology, and no malignancy was observed in any resected samples. All cases were followed up through outpatient visits or telephone, and the average follow-up time was 7.55 months (range, 1–16 months). The umbilical incisions healed without complications, and there were no complaints of umbilical discomfort.TPRT was found to be safe, time-saving, cost-efficient, and easy to perform and learn.

Laparoscopy; Myomectomy; Umbilical incision; Leiomyoma; Transumbilical paring and retrieving techniques; Transumbilical laparoendoscopic single-site surgery

[1] Aksoy H, Aydin T, Özdamar Ö, Karadag ÖI, Aksoy U. Successful use of laparoscopic myomectomy to remove a giant uterine myoma: a case report. Journal of Medical Case Reports. 2015; 9: 286.

[2] Sun Dawei. Expert opinion on single-hole laparoscopic surgery in gynecology. Chinese Journal of Obstetrics and Gynecology. 2016; 724–726. (In Chinese)

[3] Sun Xuejie, Han Lu. Parasitic leiomyoma after laparoscopic myomectomy: a report of 2 cases and literature review. Chinese Journal of Minimally Invasive Surgery. 2018; 18: 955–957. (In Chinese)

[4] Steiner R A, Wight E, Tadir Y, Haller U. Electrical cutting device for laparoscopic removal of tissue from the abdominal cavity. Obstetrics & Gynecology. 1993; 81: 471–474.

[5] Denschlag D, Ackermann S, Battista MJ, Cremer W, Egerer G, Follmann M, et al. Sarcoma of the uterus. Guideline of the DGGG and OEGGG (S2k Level, AWMF Register Number 015/074, February 2019). Geburtshilfe und Frauenheilkunde. 2019; 79: 1043–1060.

[6] Wu Haijing, Zhang Guonan. Research progress of peritoneal disseminated leiomyomatosis. Chinese Journal of Obstetrics and Gynecology. 2015; 50: 232–234. (In Chinese)

[7] Lang Jinghe, Zhang Guonan, Xiang Yang, Di Wen, Li Xiaoping, Yang Xingsheng, et al. Consensus of Chinese experts on laparoscopic uterine (myoma) fragmentation. Chinese Journal of practical Gynecology and Obstetrics. 2020; 36: 626–632. (In Chinese)

[8] Halaska M J, Haidopoulos D, Guyon F, Morice P, Zapardiel I, Kesic V; ESGO Council. European society of gynecological oncology statement on fibroid and uterine morcellation. International Journal of Gynecological Cancer. 2017; 27: 189–192.

[9] U.S. Food & Drug Administration. UPDATE: The FDA recommends performing contained morcellation in women when laparoscopic power morcellation is appropriate [EB/OL]. 2020. Available at: https://www.fda.gov/medical-devices/surgery-devices/laparoscopic-power-morcellators (Accessed: 09 March 2023).

[10] Wang Xiaoying, Li Yan. Modified transumbilical single-hole laparoscopic myomectomy. Chinese Journal of Minimally Invasive Surgery. 2019; 19: 919–921. (In Chinese)

[11] Liu Gaoyan, Ma Qinglian, Liu Peng. Application of transvaginal apple peeling in laparoscopic total hysterectomy. Medical Clinical Research. 2015; 32: 1739–1741. (In Chinese)

[12] Munro MG, Critchley HOD, Fraser IS. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertility and Sterility. 2011; 95: 2204–2208.e3.

[13] Moon HS, Jeong K, Lee SR. Robotic-assisted single incision myomectomy in large myoma cases. Clinical and Experimental Obstetrics & Gynecology. 2017; 44: 283–287.

[14] Peker N, Gündoğan S, Şendağ F. Laparoscopic management of huge myoma nascendi. Journal of Minimally Invasive Gynecology. 2017; 24: 347–348.

[15] Song JY. Laparoscopic resection of a rare, large broad ligament myoma. Journal of Minimally Invasive Gynecology. 2015; 22: 530–531.

[16] Liu Fujun. Dissemination and prevention of tissue comminution in laparoscopic hysteromyoma surgery. Study on Cancer Prevention and Teatment. 2017; 44: 627–630. (In Chinese)

[17] Steller C, Cholkeri-Singh A, Sasaki K, Miller CE. Power morcellation using a contained bag system. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2017; 21: e2016.00095.

[18] Serur E, Zambrano N, Brown K, Clemetson E, Lakhi N. Extracorporeal manual morcellation of very large uteri within an enclosed endoscopic bag: our 5-year experience. Journal of Minimally Invasive Gynecology. 2016; 23: 903–908.

[19] Mowers EL, Skinner B, McLean K, Reynolds RK. Effects of morcellation of uterine smooth muscle tumor of uncertain malignant potential and endometrial stromal sarcoma: case series and recommendations for clinical practice. Journal of Minimally Invasive Gynecology. 2015; 22: 601–606.

[20] Shi Yu, Liu Hong, Zhang Guonan, Huang Jing, Wang Dengfeng, Shi Xunwei, et al. Analysis of the efficacy and safety of disposable endoscopic specimen bag in laparoscopic uterine (myoma) fragmentation. Tumor Prevention and Treatment. 2020; 33: 395–400. (In Chinese)

[21] Park J, Kim T, Kang H, Lee Y, Choi CH, Lee J, et al. Laparoendoscopic single site (less) surgery in benign gynecology: perioperative and late complications of 515 cases. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2013; 167: 215–218.

[22] Ma Yingchun, Guan Xiaoming. Application of robotic single port laparoscopic surgery in the field of gynecology. Obstetrics-Gynecology and Genetics. 2015; 44–47.

[23] Gao Jinghai, Jin Zhijun, Li Junping, Zhang Yujiao, Xu Bingxue, Liu Xiaojun. Robot-assisted transumbilical single port laparoscopy in the treatment of cervical invasive carcinoma: clinical analysis of 12 cases. Journal of Gynecology Obstetrics and Human Reproduction. 2019; 35: 797–800. (In Chinese)

[24] Lv Xiaohui, Guo Xin, Li Jia, Li Lingxia, Yang Hong, Zou Wei, et al. Primary study on robotic single-site laparoscopy in gynecological surgery. Chinese Journal of Laparoscopic Surgery. 2019; 12: 154–158.

[25] Zhang Y, Kohn J R, Guan X. Single-incision hysterectomy outcomes with and without robotic assistance. Journal of the Society of Laparoendoscopic Surgeons. 2019; 23: e2019.00046.