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. 2025 Feb;311(2):375-383.
doi: 10.1007/s00404-024-07706-9. Epub 2024 Sep 9.

Factors affecting gasless reduced-port laparoscopic myomectomy (GRP-LM) using a subcutaneous abdominal wall lifting method: a retrospective analysis of a large cohort of 966 cases in Japan

Hiroe Ito  1 , Yasukazu Sagawa  2 , Junko Nakagawa  3 , Tomoyoshi Akaeda  4 , Kiyoaki Tsutsumi  5 , Keiichi Isaka  2   6
Affiliations

Factors affecting gasless reduced-port laparoscopic myomectomy (GRP-LM) using a subcutaneous abdominal wall lifting method: a retrospective analysis of a large cohort of 966 cases in Japan

Hiroe Ito et al. Arch Gynecol Obstet. 2025 Feb.

Abstract

Objective: To evaluate the usefulness of gasless reduced-port laparoscopic myomectomy (GRP-LM) using a subcutaneous abdominal wall lifting method.

Methods: In GRP-LM, after lifting the abdominal wall by a subcutaneous abdominal wall lifting method, a 1.5-cm incision is made in the lateral abdomen, Lap Protector® is placed. The operation is performed by two surgeons, one who inserts multiple forceps from the Lap Protector and performs the operation, and an assistant who operates the laparoscope and uterine manipulator. The surgical outcome of GRP-LM and the factors that affect it were investigated.

Results: GRP-LM was performed in 966 patients. Complications (0.5%) and blood transfusions (0.3%) were remarkably rare, and there were no cases of conversion to open surgery. With regard to the correlation between the number of fibroids extracted and each factor, the number of fibroids extracted correlated with fibroid weight and operation time, but not with blood loss. The average number of sutures per case was 21, and the average suture and ligation time per suture was 77 s. Comparing the cost of GRP-LM with that of the conventional insufflation LM, a saving of $875 was possible with GRP-LM.

Conclusion: GRP-LM is a suitable for multiple fibroids, and is cosmetic and economical, because it allows rapid and reliable suture and ligation, despite having only one port for the procedure.

Keywords: Gasless surgery; Laparoscopic myomectomy; Reduced port surgery; Subcutaneous abdominal wall lifting method.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no conflicts no conflicts of interest and nothing to disclose. Consent for publication: Not applicable. Disclosure statement: No competing final interest exist. Ethical approval and consent to participate: This study was approved by the Institutional Review Board of Tokyo Medical University (Approval No. T2020-0070), and conducted in accordance with the principles of the Declaration of Helsinki. Signed informed consent was obtained from all patients for the surgical procedure and the use of individual data for research.

Figures

Fig. 1
Fig. 1
Equipment required for the subcutaneous abdominal wall lifting. They are the lifting bar, the lifting handle, the Kirschner stainless needle (1.2 mm), and the Nelaton catheter and pliers
Fig. 2
Fig. 2
Fibroid sectioning using a MemoBag®. A Extraction of the MemoBag with fibroids retrieved out of the abdominal cavity. B Reattach the Lap Protector to the abdominal wall. C Morcellation of the fibroid using a scalpel
Fig. 3
Fig. 3
Comparison of operative time, weight of fibroids and blood loss based on No. of fibroids extracted
See this image and copyright information in PMC

References

    1. Dubuisson J-B, Fauconnier A, Babaki-Fard K, Chapron C (2000) Laparoscopic myomectomy: a current view. Hum Reprod Update 6:588–594. 10.1093/humupd/6.6.588 - DOI - PubMed
    1. Nagai H, Inaba T, Kamiya S (1991) A new method of laparoscopic cholecystectomy. An abdominal wall lifting technique without pneumoperitoneum. Abstract Surg Laparosc Endosc 1:126 - DOI
    1. Hashimoto D, Nayeem SA, Kajiwara S, Hoshino T (1993) Laparoscopic cholecystectomy: an approach without pneumoperitoneum. Surg Endosc 7:54–56. 10.1007/BF00591239 - DOI - PubMed
    1. Isaka K, Nakajima A, Ogawa T et al (1996) Usefulness of newly developed subcutaneous one point lifting method in gynecological laparoscopic operation. Nihon Sanka Fujinka Gakkai Zasshi 48(1):53–60 - PubMed
    1. Ito H, Moritake T, Terauchi F, Isaka K (2021) Introduction of gasless laparoscopic surgery as a minimally invasive procedure for endometrial cancer and its usefulness from the viewpoint of the learning curve. World J Surg Oncol 19:347. 10.1186/s12957-021-02453-6 - DOI - PMC - PubMed