Laparoscopic circumsuturing of the peritumour seromuscular layer

Laparoscopic circumsuturing of the peritumour seromuscular layer is a new surgical method that was approved for use by our centre in 2018 (figure 1). In our patients, the suture needle was first injected into the serous layer at the starting point 1–2 cm outside the fibroid. The needle was drawn around the edge of the tumour without penetrating the mucosa. After the first needle was drawn, the knot was tied without cutting the tail to continue the suture. Stitches were spaced 2–3 cm apart each time, and the thread was knotted after each stitch. The suture encompassed approximately 75% of the area around the tumour in a ‘C’ shape. The thread remained uncut, and a unipolar electrical hook was then used to cut through the myoplasmic muscle layer in the middle of the tumour until the fibroid was exposed. After this operation, almost no significant bleeding or even oozing of blood on the surface of the tumour occurred. Remaining fibroids were sutured in the original way, forming a circle around the ‘O’ shape. The fibroids were peeled until they reached the base of the fibroids, where blood vessels could be attached. Continuous suturing was then performed at the base of the fibroid. Finally, the suture was knotted and tightened, and the fibroids were completely removed. The remainder of the uterus was sutured to further compress vessels for haemostasis and to promote wound healing. During the entire operation, no massive bleeding occurred in the endoscopic field.

Schematic diagram and photos of the main surgical procedures of continuous seromuscular circumsuture for uterine fibroids myomectomy under laparoscopy. (A) Lateral view of circumsuture of uterine fibroids. (B) Schematic diagram of annular suture section during the resection of multiple uterine myomas. (C–F) Photos of the surgical process of myomectomy with circular suture. (C) Needle insertion and needle distance. (D) A C-shaped suture is formed around the uterine fibroid. (E) Carefully and integrally remove the uterine fibroids. (F) Close the wound and tie with a little tension.