To show feasibility and suggestions in performing a myomectomy of a 21x11x15 fundal subserosal fibroid using single site laparoscopy with one lateral port

Design: Narrated step-by-step video demonstration.

Setting: Single academic institution

Patients or Participants: Single patient

Interventions:

With advances in robotic technology, single incision laparoscopic surgery has been used routinely at our institution to perform complex surgeries while maximizing cosmesis. We highlight a patient seeking the most minimally invasive approach, having been evaluated by four clinics in four states, all of whom counseled the patient that a minimally invasive procedure would not be possible. Estimated blood loss was 100ml due to pre-procedure rectal Cytotec (400mcg), liberal use of vasopressin into the fibroid capsule, and the use of a vessel sealing device. Uterine serosal incision placement is also key, and we recommend five centimeters from the true uterus to aid in hemostasis. A single-site umbilical incision utilizes instrumentation through a single incision, without the need to create another large defect for fibroid morcellation, in addition to the possibility of same-day discharge. Lastly, robotics allows for joint articulation and finer dissection while improving surgeon ergonomics and comfort.

Measurements and Main Results: Completion of large myomectomy with minimally invasive approach

Conclusion: This video highlights the strategies used to perform a single site laparoscopic surgery with one lateral port for a large subserosal fibroid in a patient wishing to preserve fertility, with a history of significant keloid formation.