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

This study presents a novel two-port technique for laparoscopic myomectomy, examining perioperative outcomes from 87 cases DESIGN: Retrospective case series.

Tertiary academic hospital in Norfolk, Virginia.

Patients who underwent two-port laparoscopic myomectomy over a six-year period, performed by a single fellowship-trained surgeon. Cases were identified via current procedural terminology (CPT) codes for laparoscopic myomectomy.

The two-port technique uses a multi-port system at the umbilicus, a 45-degree bariatric laparoscope, and a 5-mm trocar in the right lower quadrant. This method reduces abdominal incisions, improves traction for fibroid removal, enhances triangulation for laparoscopic suturing, and expedites specimen extraction.

Eighty-seven patients were included, with a mean age of 37.5 years (±5.2). The most common fibroid type was FIGO type 2-5. An average of 3.6 fibroids (±3.1) were removed per case. The mean dominant fibroid diameter was 5.2 cm (±2.3), and the mean total fibroid weight removed was 139.8 grams (±114.4). The mean EBL and operative time were 128 mL (±138.9) and 153 minutes (±45.9), respectively. Fibroid number and weight correlated with increasing operative time, while fibroid weight significantly correlated with higher EBL. No conversions to laparotomy occurred. Most patients (74.7%) were discharged on the same day.

Two-port laparoscopic myomectomy is a safe and effective option for a variety of fibroid types, with outcome data comparable to previously reported data on conventional laparoscopic methods. This technique combines the benefits of traditional triangulation with improved cosmesis of single-site surgery, while providing a dedicated specimen extraction site. Candidates for two-port myomectomy are those eligible for a conventional laparoscopic approach; however, challenges may arise with intramural fibroids >10 cm, multiple fibroids (≥4), or need for multiple hysterotomy incisions, requiring careful patient selection and surgeon discretion.

For properly selected patients, a two-port laparoscopic myomectomy technique is safe, effective, and associated with favorable outcomes, including a high same-day discharge rate and minimal complications.