# 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

## TL;DR

This study evaluates a gasless laparoscopic myomectomy technique in 966 patients, showing it is safe, effective, and cost-efficient for removing multiple fibroids with minimal complications.

## Contribution

The study introduces a gasless reduced-port laparoscopic myomectomy method with a subcutaneous abdominal wall lifting technique, demonstrating its safety and cost-effectiveness.

## Key findings

- GRP-LM had very low complication and transfusion rates with no conversions to open surgery.
- The number of fibroids extracted correlated with fibroid weight and operation time but not blood loss.
- GRP-LM saved $875 per case compared to conventional insufflation laparoscopic myomectomy.

## Abstract

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

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.

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.

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.

The online version contains supplementary material available at 10.1007/s00404-024-07706-9.