Laparoendoscopic single site myomectomy versus conventional laparoscopic myomectomy for uterine myomas: a systematic...

Although uterine myomas can be treated with drugs, uterine artery embolization, and high-intensity focused ultrasound, myomectomy is still the most commonly used treatment in women who wish to preserve fertility. This study aimed to assess the current evidence regarding the safety, efficiency, and potential advantages of laparoendoscopic single-site myomectomy (LESS-M) for treating uterine myomas.

We comprehensively searched MEDLINE, Embase, the Cochrane Library, ClinicalTrials.gov, and the World Health Organization's International Clinical Trials Registry Platform from their inception to 16 November 2024. We included Randomized controlled trials and non-randomized studies comparing LESS-M with conventional laparoscopic myomectomy (CLM) for treating uterine myomas. The primary outcomes were perioperative complication rate, postoperative pain, and cosmetic satisfaction. The secondary outcomes included operative time (min), estimated blood loss (ml), hemoglobin drop, blood transfusion, blood transfusion, conversion to laparotomy rate, first exhaust time, postoperative ambulation time, postoperative hospital stay. All analyses were performed using random-effects or fixed-effects models. Exploration of causes of clinical heterogeneity was planned using subgroup analysis and sensitivity analysis.

We included 20 studies including 2766 patients in the final analysis. There were no significant differences between LESS-M and CLM in terms of perioperative complication rate (RR, 1.19; 95% CI, 0.65 to 2.18; P = 0.50), postoperative pain scores at 6 h (WMD, -0.25; 95% CI, -0.53 to 0.03; P = 0.08), 24 h (WMD, -0.16; 95% CI, -0.41 to 0.09; P = 0.22), and 48 h (WMD, -0.05; 95% CI, -0.21 to 0.12; P = 0.58). There were also no differences in terms of operative time ( P = 0.56), estimated blood loss ( P = 0.36), hemoglobin drop ( P = 0.77), blood transfusion ( P = 0.87), and first exhaust time ( P = 0.60) between both techniques. LESS-M was associated with higher cosmetic satisfaction ( P < 0.00001), reduction in postoperative pain scores at 1 h ( P = 0.0008) and 12 h ( P = 0.001), shorter postoperative ambulation time ( P = 0.02) and hospital stay ( P = 0.003) comparing with CLM.

Available evidence suggests that LESS-M may have advantages in some short-term outcomes compared to CLM. However, these findings are primarily based on non-randomized studies, and further high-quality randomized controlled trials are needed to confirm these results.