Laparoscopic Two-Port Myomectomy—a Retrospective Case Series of a Novel Minimally Invasive Approach

INTRODUCTION: Laparoscopic myomectomy (LSC-M) allows for minimally invasive intervention and uterine preservation, with significant benefits and improved patient outcomes compared with laparotomic approach. Several established methods exist for LSC-M. Here, we present LSC-M using two ports as a novel approach performed by our institution for more than six years. The two-port method (TPM) combines aspects of traditional laparoscopy and single-site surgery. There are several benefits to this approach, including reduction of the number of abdominal incisions required, improved traction for fibroid removal, improved triangulation for laparoscopic suturing, and expedited removal of small fibroids from the abdomen. OBJECTIVE: The objective of this study is to review a series of 87 cases of laparoscopic myomectomy utilizing this two-port approach, observing the patient population characteristics and perioperative outcomes. METHODS: This case series evaluated 87 adult patients who underwent LSC-M using a two-port approach over a 6-year period between January 2018 and December 2023 with a fellowship-trained surgeon in minimally invasive gynecological surgery at a tertiary surgical referral center. Data was collected from retrospective chart review. Outcomes of interest included patient demographics and intraoperative variables, such as total number of fibroids removed, size and location of fibroids removed, operative time, estimated blood loss (EBL), and incidence of intraoperative complications. Postoperative variables were also included, such as length of stay and occurrence of any postoperative complications within 30 days of surgery. The study has been approved by our institution’s Institutional Review Board. RESULTS: The average patient was 37.5 years old with body mass index of 26.5 kg/m2. An average of 2 fibroids were removed per case, with a range from 1 to 14 fibroids. Five or more fibroids were removed in 28.7% of cases. A wide variety of fibroids by FIGO classification could be removed from this method, with representation from each subclass. The mean fibroid size was 5.2 cm (range 2.5 to 13.7 cm), and mean total fibroid weight removed was 73.5 g (range 6.2 to 547 g). The mean estimated blood loss (EBL) was 128 mL, and 3.4% of patients had EBL of 500 mL or more. The mean operative time was 153 min (range 56 to 273 min). One patient had to be converted from LSC-M to open mini-laparotomy for case completion. Most patients met criteria for same-day discharge (74.7%), while the remaining 25.3% were discharged on postoperative day 1. Three patients (3.4%) experienced a minor (Clavien-Dindo grades I–II) postoperative complication within 30 days from surgery-blood transfusion and postoperative urinary retention. One patient (1.1%) experienced a major (Clavien-Dindo grades III-V) complication—small bowel obstruction requiring reoperation (Figure 1). CONCLUSIONS: Laparoscopic myomectomy can be successfully completed with two ports and should be considered a safe alternative to traditional laparoscopic port set-up (Tables 1 and 2).