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Page 2 of 13 Tang. Mini-invasive Surg 2020;4:24 I http://dx.doi.org/10.20517/2574-1225.2019.60

myoma number. There were differences in blood loss (P = 0.0359) and operation time (P = 0.0537) based on the
maximum diameter of myoma. No learning curve was noted in the cumulative sum control chart analysis of the 31
consecutive cases.

Conclusion: In our 31 consecutive cases, the operation time, blood loss, and postoperative VAS score were all
comparable to the previously published literature for single-port laparoscopic myomectomy. It is feasible for virgin
women with symptomatic myoma to receive single-port laparoscopic myomectomy.

Keywords: Single-port laparoscopy, myoma uteri, virgin

INTRODUCTION
Myoma uteri, a monoclonal smooth muscle cell tumor, is the most common benign gynecologic tumor
[1]
in women in childbearing age. Its prevalence varies from 4.5% to 68.6% in different studies and tends to
[2]
increase with age . The self-reported prevalence of myoma uteri is 1.8% in 20-29-year-old women, but it
[2]
increases to 7.0% and 14.1% in the 30-39- and 40-49-year-old groups, respectively .
The symptoms of myoma uteri are annoying and negatively impact the quality of life. Over one third of
patients report heavy menstrual bleeding, prolonged duration of menstrual bleeding, and bleeding between
periods . Moreover, over 50% of women with myoma uteri report having pain and abdominal cramps
[2]
during periods, nearly one third report pressure on bladder or inside the abdomen, and nearly 25% feel
[2]
pain during sexual intercourse . When asked about their symptoms in the last 12 months, over half (50.6%)
[2]
of women with myoma uteri reported a negative impact on their daily life . Moreover, women with myoma
uteri have significantly higher frequency of genitourinary symptoms including stress urinary incontinence,
[3]
mixed urinary incontinence, urgency, daytime frequency, and dyspareunia .

Women with myoma uteri can only receive observation when there are no symptoms. Symptomatic myoma
needs either medical or surgical treatment. Medical treatment of myoma uteri includes levonorgestrel
intrauterine system, tranexamic acid, non-steroid anti-inflammatory drugs, contraceptive pills, and
[4]
oral or injected progestogens . These treatments can decrease menstrual blood flow or relieve pain,
but are not effective in decreasing the size of the myoma. Gonadotropin releasing hormone analogs can
effectively decrease myoma size and uterine volume . However, the side effects preclude its long-term use.
[5]
Ulipristal acetate is a selective progesterone receptor modulator that exhibits direct tissue-specific partial
progesterone antagonist effects. It is an effective option for both preoperative and intermittent treatment of
[6]
moderate to severe, symptomatic uterine fibroids in women of reproductive age . However, the long-term
[4]
effect is still not known, and in rare case it can cause severe liver damage .
Surgery is a definite treatment for symptomatic myomas, especially for large ones. The bulky effect usually
cannot regress quickly enough using non-surgical methods. Hysterectomy is performed if the patient does
not want to preserve her uterus. Myomectomy is an alternative method if the patient chooses to preserve
her uterus or the woman has not yet completed her childbearing. With the progression of minimally
invasive surgery, many surgeons who are familiar with laparoscopic surgery will choose to perform
laparoscopic myomectomy in those patients. Single-port laparoscopic myomectomy is more technically
difficult but has comparable surgical outcomes to conventional laparoscopic myomectomy, with the
[7]
[8]
benefit of good cosmetic results . In this study, we retrospectively analyzed the surgical outcomes of
31 women who had had no sexual experience with symptomatic myomas receiving single-port laparoscopic
myomectomy without using uterine manipulator to preserve their virginity in our hospital performed by
single surgeon.