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

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.