To retrospectively analyzed the therapeutic efficacy and perioperative safety of single-port laparoscopic myomectomy (SPLM) versus multiport laparoscopic myomectomy (MPLM) for large uterine fibroids.

A retrospective analysis was conducted on the clinical data of 482 patients who underwent SPLM or MPLM at the General Gynecology Center of Peking Union Medical College Hospital between Aug. 2022 and Sep. 2024. Patients with a single uterine fibroid of maximum diameter ≥10 cm were selected, including 24 cases in the SPLM group and 64 cases in the MPLM group. Surgical outcomes were evaluated based on three main aspects: 1) surgical parameters (operative time, additional trocar use, postoperative hemoglobin decrease, frequency of blood transfusion, adjacent organ injury); 2) perioperative recovery and safety indicators (pain scores at 6 h, 24 h, and 48 h postoperatively, postoperative fever, hospital stay, hospitalization costs, perioperative complications); and 3) scar cosmesis assessed using a scar evaluation and rating scale. Statistical analysis was performed using SPSS 27.0 software, with a P-value<0.05 considered statistically significant.

The operative time was 136.81±56.82 min for the SPLM group and 119.85±42.07 min for the MPLM group, with a significant difference between groups (P=0.025). The postoperative hemoglobin decrease was 18.26±8.01 g/L in the SPLM group and 17.04±7.70 g/L in the MPLM group (P=0.480). Postoperative VAS scores at 6 h, 24 h, and 48 h were significantly lower in the SPLM group compared to the MPLM group (3.88±1.14 vs. 4.51±1.15, 2.83±0.96 vs. 3.18±1.03, 1.57±0.83 vs. 1.83±0.90, respectively; all P<0.05). No statistically significant differences were found between the two groups regarding hospital stay or hospitalization costs. The total scar score was significantly lower in the SPLM group (1.21±1.18) compared to the MPLM group (5.36±2.45, P<0.001). Specifically, the SPLM group demonstrated superior outcomes in scar spread, erythema, pigmentation abnormality, suture marks, and hypertrophy/atrophy compared to the MPLM group (0.29±0.56 vs. 1.56±0.82, 0.04±0.20 vs. 0.89±0.69, 0.33±0.48 vs. 0.73±0.45, 0.21±0.41 vs. 0.98±0.13, 0.25±0.44 vs. 0.80±0.68, respectively; all P<0.001).

Single-port laparoscopic surgery is a safe and feasible treatment option for large uterine fibroids. It is superior to multiport laparoscopic surgery, particularly in terms of postoperative pain control and cosmetic outcomes.