Suprapubic laparoscopic-Assisted myomectomy

BACKGROUND: Minimally invasive myomectomy offers significant perioperative benefits including reduced pain and faster recovery. Current approaches include conventional laparoscopic myomectomy (LM), single-port LM, and mini-laparotomy. We developed a hybrid technique, termed suprapubic laparoscopic-assisted myomectomy (SLAM), that combines the superior visualization of laparoscopy with the tactile feedback and suturing efficiency of mini-laparotomy. METHODS: This retrospective comparative study evaluated the clinical rationale, safety, and feasibility of SLAM compared with conventional LM. Patients underwent conventional LM or SLAM according to patient preference following shared decision-making (SDM). Patients with a body mass index (BMI) > 30 or myoma(s) > 10 cm were excluded. All the procedures were performed by a single surgeon. Statistical analyses were performed using Student's t-test (results presented as mean ±standard deviation [SD] with 95% confidence intervals [CI]), the chi-square test, or Fisher's exact test. RESULTS: Thirty-six patients with symptomatic uterine myomas were included, with 16 undergoing SLAM and 20 undergoing conventional LM. The average hospitalization duration was 4.19 ± 0.40 days for SLAM and 4.15 ± 0.49 days for LM (p = 0.807). The operative time was comparable between the SLAM and LM groups (186.0 ± 59.3 min vs. 213.8 ± 48.8 min; p = 0.133). Although estimated blood loss was lower in the SLAM group (140.6±148.3 ml vs. 197.5±223.1 ml; p = 0.387), the difference did not reach statistical significance. Hemoglobin decrease was also comparable (1.14 ± 1.63 mg/dL vs. 1.06 ± 1.87 mg/dL; p = 0.897). The blood transfusion rates were 18.8% (3/16) for the SLAM group and 15.0% (3/20) for the LM group (p = 1.000). No major complications were observed in either group. CONCLUSION: SLAM is a safe and feasible alternative to conventional LM and offers effective myometrial closure and specimen retrieval. While operative outcomes are comparable to conventional LM, SLAM provides a viable "hybrid" option for surgeons seeking to combine minimally invasive benefits with the precision of manual suturing.