Application of single-port procedure and ERAS management in the laparoscopic myomectomy

Wang et al. BMC Women's Health (2023) 23:401 https://doi.org/10.1186/s12905-023-02550-6 BMC Women's Health Open Access RESEARCH Application of single-port procedure and ERAS management in the laparoscopic myomectomy Jing Wang1, Xiaomin Xu1 and Jingui Xu1* Abstract Objective Advances in surgical techniques and perioperative management are the two major contributing factors to improved surgical outcomes. The purpose of the current study was to compare the efficacy of single-port surgery and perioperative enhanced recovery after surgery (ERAS) management in laparoscopic myomectomy. Methods The present study included 120 patients undergoing laparoscopic myomectomy in the Gynecological Ward of Quzhou Affiliated Hospital of Wenzhou Medical University. According to the traditional perioperative management mode and ERAS management, multi-port and single-port procedures, all patients were assigned to the Conventional-SPLS (Single-Port Laparoscopic Surgery with conventional perioperative care) group (n = 34), Conventional-Multi (multi-port laparoscopic surgery with conventional perioperative care) group (n = 47), and ERAS (multi-port laparoscopic surgery with ERAS perioperative care) group (n = 39). The surgical outcomes of the three groups were compared operation time, intraoperative blood loss, variations in postoperative hemoglobin, postoperative walking time, postoperative flatus expelling time, postoperative hospital stay, and visual analog scale (VAS) scores at 6 and 12 h following surgery. Results The ERAS group recovered the quickest in terms of postoperative walking time and flatus expelling duration. The ERAS group also recovered the shortest postoperative hospital stay (3.85 ± 1.14 days), which differed significantly from that in the Conventional-Multi group, but not significantly from that in the Conventional-SPLS group. In terms of VAS scores at 6 and 12 h after surgery, the ERAS group had the lowest pain intensity, which differed significantly from that of the other two groups. The effect of surgical procedures or postoperative care on hospital stay was assessed using multiple regression analysis. The results demonstrated that ERAS was an important independent contributor to reducing postoperative hospital stay (β = 0.270, p = 0.002), while single-port surgery did not affect this index (β = 0.107, p = 0.278). Conclusion In laparoscopic myomectomy, perioperative ERAS management could control postoperative pain and shorten hospital stay. Single-port surgery could speed up the recovery of gastrointestinal function and postoperative walking time, but it did not affect postoperative pain management or the length of hospital stay. Thus, the most effective approach to improving postoperative outcomes in laparoscopic myomectomy was the application of perioperative ERAS management. *Correspondence: Jingui Xu Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Wang et al. BMC Women's Health (2023) 23:401 Page 2 of 7 MeSH keywords Enhanced recovery after surgery, Laparoscopy, Myomectomy Introduction The myomectomy can preserve fertility and maintain the anatomical integrity of the pelvic floor. Patients are increasingly selecting laparoscopic myomectomy because of the rapid advancement of minimally invasive procedures. However, using a fibroid morcellator and other issues limit the application of this procedure. The laparoscopic electric fibroid morcellator has been widely used in laparoscopic myomectomy since the U.S. Food and Drug Administration (FDA) approved its clinical use in 1995. As the widespread application, related problems have attracted increasing attention. The high-speed rotating blades of the fibroid morcellator may damage surrounding organs, and the incidence is 0.007-0.02% [1]. It may also lead to the dissemination of lesions, such as parasitic leiomyomata, iatrogenic endometriosis, and cancer progression [2]. Qin Chen et al. retrospectively reviewed the data of 4478 patients undergoing laparoscopic myomectomy, and the incidence of uterine sarcomas was 0.54%. Uterine sarcoma incidence in people aged 50 to 60 years was as high as 10/375 (2.6%), and using a fibroid morcellator increased the risk of malignant tumors spreading to the abdominopelvic cavity [3]. Thus, the FDA stated the application of fibroid morcellator and warnings in 2014, limiting the application of laparoscopic myomectomy. In recent years, transumbilical single-port laparoscopic surgery has undergone rapid development. This procedure makes an incision in the umbilical region that is 2.5-3.0 cm long. With the aid of an “apple-peeling” technique, the fibroids are taken out, placed in a retrieval bag, and then taken out of the incision. This procedure avoids problems associated with the use of a fibroid morcellator and the potential risk of lesion dissemination, and it is also more aesthetically pleasing and safer [4]. However, it necessitates more advanced laparoscopic techniques for surgeons, a longer duration of surgery, and a learning curve [5, 6]. Historically, the classic motto of postoperative management was “wait and see”. There was little data on perioperative care, such as intestinal preparation, dietary management, pain control, early mobilization, etc. In recent years, there has been a paradigm shift towards a more positive attitude. ERAS was first described by Danish surgeon Kehlet in 1997 [7], and using the principles of evidence-based medicine, it made several perioperative adjustments to speed the recovery of various tissues and organs after surgery [8].The goal of ERAS is to reduce the physiological pressure of surgery and optimize patient recovery. Before surgery, this is achieved by optimizing chronic diseases and nutrition,counseling and education,no mechanical bowel preparation,oral carbohydrate loading. During the surgical process, the goal is to minimize pain and gastrointestin (...truncated)