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Tang. Mini-invasive Surg 2020;4:24 I http://dx.doi.org/10.20517/2574-1225.2019.60 Page 9 of 13

Table 5. Comparison of surgical outcomes with previous published studies [18,19,21-24]
Our studies Previous published studies
Mean number of myoma 3.84 ± 2.45 1-3 to 1-5
Mean diameter of max myoma (cm) 11.24 ± 3.27 7-14
Operation time (min) 182.32 ± 52.39 77.5 ± 37.8 to 191.4 ± 103.0
Blood loss (mL) 231.77 ± 238.90 114.2 ± 157.0 to 224.6 ± 320.9
VAS score 2.32 ± 1.06* 1.60 ± 1.30 to 3.50 ± 0.8
1.23 ± 1.43**
*Immediately arrive ward after operation; **24 hours later. VAS: visual analogue score

Concerning the obstetric outcome, both groups show no significant differences in pregnancy rate, abortion
[14]
rate, and preterm delivery rate .
Recently, technological innovations (such as a multichannel single port, articulating instruments, and
high-definition laparoscopes) have allowed laparoscopic surgeons to perform gynecologic surgery through
only one small incision over the abdomen (single-port laparoscopic surgery) with the aim of further
reducing the invasiveness of conventional laparoscopy. There are many reports applying this new method
to gynecologic surgeries such as hysterectomy, adnexal surgery, or even cancer surgery [15-17] . Its use in
myomectomy is limited to advanced laparoscopic surgeons due to the difficulty of multiple suturing and
[7]
tying . However, there are more and more reports on the feasibility and safety of this difficult method [18-22] .

In a systematic review and meta-analysis comparing single-port laparoscopic myomectomy with
[19]
conventional laparoscopic myomectomy published in 2019, Kim et al. concluded that single-port
laparoscopic myomectomy is comparable to conventional laparoscopic myomectomy in terms of safety
and feasibility and more advantageous in terms of immediate postoperative pain. However, virginity is not
mentioned in the literature they included. To the best of our knowledge, this is the first study reporting on
the use of single-port laparoscopic myomectomy in virgins.

As is known, it is more difficult in laparoscopic gynecologic surgery to not use a uterine manipulator,
especially in myomectomy, which needs the uterine manipulator to change the position of the uterus for
proper surgical plane when dissecting myoma and suturing the uterine wall defect.

In our study, the mean number of myoma in a single patient was 3.84 ± 2.45, which is comparable to
previous studies [18,19,21-25] , which range from 1-5. However, in one patient in our study, 10 myomas were
removed in the same operation, which we believe is the most reported in the literature in a single-port
laparoscopic myomectomy. The mean diameter of maximum myoma in single patient was 7-14 cm in those
studies, and in our study was 11.24 ± 3.27 cm. The maximum diameter of single myoma removed in our
study was 20 cm, which we believe is the largest diameter of myoma removed by single-port laparoscopic
surgery reported in the literature. The mean operation time in our study was 182.32 ± 52.39 min, which
is also comparable to those studies (from 77.5 ± 37.8 min to 191.4 ± 103.0 min). The mean blood loss was
231.77 ± 238.90 mL in our study. The mean blood loss in previous studies ranges from 114.2 ± 157.0 mL to
224.6 ± 320.9 mL. However, there were two extreme values in our study, while the median value of blood
loss was 150 mL. We believe the blood loss is comparable to those previous studies. The VAS score in our
study was 2.32 ± 1.06 when patients arrived at the ward after operation and 1.23 ± 1.43 24 h later, which is
also comparable to those studies (from 1.60 ± 1.30 to 3.50 ± 0.8).

In total, 119 myoma were removed in our study, with 51 (42.86%) being > 5 cm in diameter. All the
posterior intramural and broad ligament type myomas were > 5 cm. Overall, 36 of 58 (62.1%) intramural
myomas were > 5 cm. Most subserous type myomas were small; only 15 of 52 (28.8%) were > 5 cm. These
results are similar to the reference values.