A comparison of three approaches for laparoscopic single-site (LESS) myomectomy: conventional, robotic, and hand assiste
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ORIGINAL ARTICLE
A comparison of three approaches for laparoscopic single‑site (LESS) myomectomy: conventional, robotic, and hand assisted Weihua Luo1,2 · Kristina Duan1 · Ning Zhang2 · Stephanie Delgado1 · Zhenkun Guan3 · Xiaoming Guan1 Received: 9 June 2020 / Accepted: 25 September 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract The objective of this study is to determine the feasibility and explore criteria for patient selection for three methods of LESS myomectomy: conventional (C-LESS), robotic-assisted (RA-LESS), and hand-assisted (HA-LESS). This was a retrospective case review of 72 patients with uterine myomas, conducted in a large academic tertiary care hospital between March 1, 2015, and November 7, 2018. LESS myomectomy via conventional, robotic, and hand-assisted routes. 43 patients underwent C-LESS, 15 underwent RA-LESS, and 14 underwent HA-LESS, with no conversions to open abdominal myomectomy. The operative outcomes were compared across the three approaches. The HA-LESS group had the largest mean number (HA: 6.9; C: 3.7; RA: 2.9, P=0.001), diameter (HA: 11.3 cm; C: 9.3 cm; RA: 7.1 cm, P=0.035), and weight (HA: 850.1 g; C: 320.7 g; RA: 181.1 g, P=0.003) of myomas removed per patient. The use of this method was also found to have a direct correlation with estimated preoperative uterine size (HA: 20.1 weeks; C: 16.2 weeks; RA: 12.0 weeks, P=0.001. Operative time and postoperative stay were found to be not statistically different across groups. We conclude that all three types of LESS myomectomy are feasible with comparable surgical outcomes. Most importantly, our findings indicate that hand assistance can be combined with C-LESS myomectomy for large or multi-fibroid uterus without compromising operating time or patient recovery. Notably, we found that uterine size could be a useful tool for the determination of the surgical approach. Keywords Single-incision laparoscopy myomectomy · Hand-assisted single-incision myomectomy · Robot-assisted singleincision myomectomy · On-site tissue extraction technique
Introduction Uterine myoma is one of the most common benign gynecologic tumors, and surgery has remained the main treatment of choice for symptomatic myomas [1]. Advances in the field of minimally invasive gynecological surgery have allowed for endoscopic management of myomatous uteri[2]. In recent years, laparoendoscopic single-site (LESS) surgery with in-bag cold knife tissue removal has been gaining interest in the field [3, 4].
* Xiaoming Guan [email protected] 1
Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main Street, 10th floor, Houston, TX 77030, USA
2
Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
3
Guangzhou Medical University, Guangzhou, China
There are three methods for executing LESS: (1) conventional laparoscopy (C-LESS); (2) robotic-assisted laparoscopy (RA-LESS); and (3) conventional laparoscopy with hand assistance (HA-LESS). Both C-LESS and RALESS myomectomy reduce the number of po
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