Perioperative outcomes, surgeon-rated fatigue, and scar satisfaction after dual-port versus single-port laparoscopic myomectomy: a propensity score–matched cohort study

Abstract Background Laparoscopic myomectomy is commonly used for women with symptomatic uterine fibroids who wish to preserve the uterus. Single-port laparoscopy reduces the number of abdominal incisions but may increase instrument crowding and ergonomic difficulty during myometrial dissection and suturing. Dual-port laparoscopy may provide a practical balance between reduced-port access and operative maneuverability. This study compared perioperative outcomes, surgeon-rated fatigue, and patient-reported scar satisfaction between dual-port and single-port laparoscopic myomectomy. Methods This retrospective cohort study included women who underwent elective laparoscopic myomectomy for solitary uterine fibroids at a tertiary center between January 2024 and November 2025. Propensity scores were estimated using age, body mass index, fibroid diameter, fibroid location, pelvic adhesion grade, medical comorbidity, and number of previous pelvic surgeries. One-to-one nearest-neighbor matching without replacement was performed with a caliper of 0.2 standard deviations of the logit of the propensity score. Primary multivariable models in the matched cohort additionally adjusted for operating surgeon and year of surgery and used matched-pair clustered robust variance estimation. Alternative-model sensitivity analyses and regression diagnostics were also performed. Results After propensity score matching, 190 women were included, with 95 patients in each group. Estimated blood loss was lower in the dual-port group (mean ± standard deviation, 45.53 ± 38.12 vs. 76.32 ± 69.94 mL; median [interquartile range], 30.0 [20.0–50.0] vs. 50.0 [30.0–100.0] mL). In the fully adjusted matched-cohort model, dual-port surgery remained associated with lower blood loss (β = −23.07 mL, 95% CI − 39.14 to − 7.01; P = 0.005), whereas the operative-time association was attenuated (β = −0.13 h, 95% CI − 0.27 to 0.00; P = 0.053). Surgeon-rated fatigue was available for 110 of 190 patients (57.9%) and scar satisfaction for 78 of 190 patients (41.1%); both were analyzed as exploratory complete-case outcomes. Postoperative recovery outcomes showed no consistent between-group pattern, and only one postoperative complication occurred. Conclusions In this propensity score–matched cohort, dual-port laparoscopic myomectomy was associated with lower estimated blood loss after adjustment for operating surgeon and year of surgery. The operative-time finding was suggestive but not independently confirmed after full adjustment. Lower surgeon-rated fatigue and lower patient-reported scar-satisfaction scores were observed in exploratory complete-case analyses, but these subjective findings require confirmation using validated instruments and standardized prospective collection.