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

Abstract

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 three groups were compared about surgical outcomes such as 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 hours following surgery. Results: In terms of postoperative walking time and flatus expelling time, the ERAS group recovered the quickest. 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 hours after surgery, the ERAS group had the lowest pain intensity, which differed significantly from that of the other two groups. The impact of surgical procedures or perioperative management on hospital stay was evaluated 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 on 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.