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Gou J, Li Z, Liao X, Nie D, Xue L, Li L. Single-incision laparoscopic hysterectomy using conventional laparoscopic instruments: initial experience with 25 cases. Arch Gynecol Obstet 2018; 298:921-926. [PMID: 30132117 DOI: 10.1007/s00404-018-4858-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/28/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the feasibility and safety of single-incision laparoscopic hysterectomy using conventional instruments. METHODS Twenty-five patients undergoing single-incision laparoscopic hysterectomy (SI-LAH) using conventional instruments at West China Second University Hospital between July, 2017 and December, 2017 were selected for participation. Another 25 cases undergoing traditional multi-port laparoscopic hysterectomy (MP-LAH) matched with similar uterine size were selected as controls. Characteristics and clinical data of patients including operative time, estimated blood loss, hospital stay, catheter retention time, and intraoperative and postoperative complications were compared between the two groups. RESULTS The baseline characteristics of the two groups were comparable. The estimated blood loss was less in SI-LAH with respect to MP-LAH (30 mL [range 20-50] vs 50 mL [range 10-200], P < 0.05), with no statistically significant difference in terms of decrease of hemoglobin level (17 g/dL [range 2-24] vs 18 g/dL [range 5-28], P > 0.05). There were no significant differences between the two groups in terms of operative time (150 min [range 85-225] vs 145 min [range 100-220], P > 0.05), intraoperative injury, catheter retention time, time to exhausting, postoperative hospital stay. In all cases, no additional port incision was needed and no conversion to laparotomy was necessary in two groups. No patient had development of intraoperative or postoperative complications. After a follow-up of 2 months, no incisional hernia occurred in all patients. CONCLUSIONS Single-incision laparoscopic hysterectomy using conventional instruments is a feasible and safe technique for patients with uterine size less than 12 weeks of pregnancy and no serious pelvic adhesion, requiring for more experienced skill of surgeons.
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Affiliation(s)
- Jinhai Gou
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zhengyu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Xin Liao
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Dan Nie
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Luqi Xue
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Lin Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
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Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet 2017; 295:1089-1103. [PMID: 28357561 PMCID: PMC5388711 DOI: 10.1007/s00404-017-4323-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/06/2017] [Indexed: 02/07/2023]
Abstract
Purpose To assess the safety and effectiveness of LESS compared to conventional hysterectomy. Methods The systematic review and meta-analysis was performed according to the MOOSE guideline, and quality of evidence was assessed using GRADE. Different databases were searched up to 4th of August 2016. Randomized controlled trials and cohort studies comparing LESS to the conventional laparoscopic hysterectomy were considered for inclusion. Results Of the 668 unique articles, 23 were found relevant. We investigated safety by analyzing the complication rate and found no significant differences between both groups [OR 0.94 (0.61, 1.44), I2 = 19%]. We assessed effectiveness by analyzing conversion risk, postoperative pain, and patient satisfaction. For conversion rates to laparotomy, no differences were identified [OR 1.60 (0.40, 6.38), I2 = 45%]. In 3.5% of the cases in the LESS group, an additional port was needed during LESS. For postoperative pain scores and patient satisfaction, some of the included studies reported favorable results for LESS, but the clinical relevance was non-significant. Concerning secondary outcomes, only a difference in operative time was found in favor of the conventional group [MD 11.3 min (5.45–17.17), I2 = 89%]. The quality of evidence for our primary outcomes was low or very low due to the study designs and lack of power for the specified outcomes. Therefore, caution is urged when interpreting the results. Conclusion The single-port technique for benign hysterectomy is feasible, safe, and equally effective compared to the conventional technique. No clinically relevant advantages were identified, and as no data on cost effectiveness are available, there are currently not enough valid arguments to broadly implement LESS for hysterectomy. Electronic supplementary material The online version of this article (doi:10.1007/s00404-017-4323-y) contains supplementary material, which is available to authorized users.
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Takeda A, Hayashi S, Imoto S, Nakamura H. Gasless single-port laparoscopic-assisted vaginal hysterectomy for large uteri weighing 500g or more. Eur J Obstet Gynecol Reprod Biol 2016; 203:239-44. [PMID: 27352286 DOI: 10.1016/j.ejogrb.2016.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 05/26/2016] [Accepted: 06/11/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the safety and feasibility of gasless transumbilical single-port laparoscopic-assisted vaginal hysterectomy (LAVH) for the management of large uteri weighing 500g or more. STUDY DESIGN We conducted a retrospective comparative study of women with large uteri, each undergoing gasless multi-port or single-port LAVH. Preoperatively, gonadotropin-releasing hormone agonist was administered and autologous blood was donated except for cases requiring immediate surgery. Additionally, intraoperative blood salvage and donation was performed in select cases. In single-port LAVH, a wound retractor was used to make a working port through umbilical incision. After the surgical view was secured using an abdominal wall-lift device, the surgical procedures were performed using conventional laparoscopic instruments. In select cases, temporary endovascular occlusion of the bilateral internal iliac arteries was performed to reduce intraoperative hemorrhaging. RESULTS Of the 650 women managed by multi-port or single-port LAVH, 55 and 67 women each with uteri weighing 500g or more, respectively, were included. In single-port LAVH group, the median age was 47 years. Twelve women were nulliparous and 3 women with 2 cesarean deliveries each, had never had a vaginal delivery. The most frequent surgical indication was uterine myoma. In the single-port LAVH group, the surgical procedures included LAVH alone (n=36), LAVH and bilateral salpingo-oophorectomy (n=22), LAVH and unilateral salpingo-oophorectomy (n=8), and LAVH and appendectomy (n=1). Extensive adhesiolysis was required in eight cases. The median extirpated tissue weight was 652g with a median estimated intraoperative blood loss of 450mL. A significant positive linear correlation was observed between the operative time or estimated blood loss and the extirpated uterine weigh. Although excessive bleeding exceeding 1000mL was noted in 15 cases, a transfusion of bank blood was not required by using preoperatively donated autologous blood and intraoperative autologous blood salvage and donation. Extended hospitalization was required in six cases. The median surgical duration in the single-port LAVH group was significantly longer than that in the multi-port LAVH group. CONCLUSION Gasless single-port LAVH is a feasible alternative that can yield similar major surgical outcomes as multi-port LAVH, with potential cosmetic benefit.
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Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.
| | - Shotaro Hayashi
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Sanae Imoto
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Hiromi Nakamura
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
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Yang L, Gao J, Zeng L, Weng Z, Luo S. Systematic review and meta-analysis of single-port versus conventional laparoscopic hysterectomy. Int J Gynaecol Obstet 2015; 133:9-16. [PMID: 26797206 DOI: 10.1016/j.ijgo.2015.08.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 07/30/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The choice between single-port laparoscopic hysterectomy (SPLH) and conventional laparoscopic hysterectomy (CLH) remains unclear. OBJECTIVES To evaluate the feasibility, safety, and comparative effectiveness of SPLH and CLH. SEARCH STRATEGY PubMed, Web of Science, and the Cochrane Library were searched in February 2015 using combinations of the terms "single port," "single incision," "single site," "laparoscopic hysterectomy," and "laparoendoscopic hysterectomy." SELECTION CRITERIA Randomized controlled trials (RCTs) and retrospective studies comparing SPLH and CLH were included if they reported at least one quantitative outcome. DATA COLLECTION AND ANALYSIS Study characteristics, quality, and outcomes were assessed. The primary outcomes were procedure failure and perioperative complications. Odds ratio (ORs) and 95% confidence intervals (CIs) were calculated. MAIN RESULTS Eighteen studies (6 RCTs, 12 retrospective studies) were included. As compared with CLH, SPLH had a higher failure rate (OR 6.37, 95% CI 3.34-12.14; P<0.001). The frequency of perioperative complications did not differ (OR 0.89, 95% CI 0.45-1.74; P=0.73). CONCLUSIONS There is no significant difference in the frequency of perioperative complications between SPLH and CLH. However, the higher rate of procedure failure in SPLH should be taken into consideration.
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Affiliation(s)
- Lilin Yang
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jie Gao
- Department of Gynecology, First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lei Zeng
- Department of Gynecology, First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhiwei Weng
- Department of Reproductive Medicine, First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Songping Luo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Torng PL, Lin KH, Hwang JS, Liu HS, Chen IH, Chen CL, Huang SC. Learning curve for laparoendoscopic single-site surgery for an experienced laparoscopic surgeon. Gynecol Minim Invasive Ther 2013. [DOI: 10.1016/j.gmit.2013.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Rabischong B, Compan C, Savary D, Bourdel N, Canis M, Mage G, Botchorishvili R. La laparoscopie par incision unique en gynécologie : état des lieux en 2013. ACTA ACUST UNITED AC 2013; 42:445-57. [DOI: 10.1016/j.jgyn.2013.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/26/2013] [Accepted: 03/27/2013] [Indexed: 11/16/2022]
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Choi YS, Park JN, Oh YS, Sin KS, Choi J, Eun DS. Single-port vs. conventional multi-port access laparoscopy-assisted vaginal hysterectomy: comparison of surgical outcomes and complications. Eur J Obstet Gynecol Reprod Biol 2013; 169:366-9. [PMID: 23664457 DOI: 10.1016/j.ejogrb.2013.03.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 10/14/2012] [Accepted: 03/25/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare surgical outcomes and complications between single-port access (SPA) and multi-port access (MPA) laparoscopy-assisted vaginal hysterectomy (LAVH). STUDY DESIGN A retrospective review of medical records was performed in patients who underwent LAVH for non-malignant gynaecological diseases at Eun Hospital between April 2010 and April 2012. One hundred and twenty women underwent SPA LAVH using a transumbilical three-channel single-port system and 130 women underwent conventional MPA LAVH. Surgical outcomes and complications were compared between the two groups. RESULTS The outcomes of the SPA-LAVH group vs. the conventional MPA-LAVH group were as follows: mean±standard deviation total operative time (73.1±24.3 vs. 70.3±22.1min, p=0.349), largest dimension of uterus (10.7±2.3 vs. 10.8±2.8cm, p=0.847), weight of extirpated uterus (311±185 vs. 339±234g, p=0.298) and change in haemoglobin (1.7±0.8 vs. 2.0±0.9g/dl, p=0.025). The incidence of complications was similar in each group (20 vs. 16 patients, p=0.327). Unplanned intra-operative laparotomy was not necessary in either group, and there were no cases of bowel injury or main vessel injury in either group. In total, there were three bladder injuries: one in the SPA-LAVH group and two in the MPA-LAVH group. The postoperative course was uneventful in most patients, but six patients had a transient paralytic ileus (four in the SPA-LAVH group and two in the MPA-LAVH group) and 10 patients had a pelvic haematoma (five in each group), all of whom recovered following conservative management. Port-related complications were rare, but one patient in the SPA-LAVH group had a port-site umbilical hernia. CONCLUSION Use of SPA and MPA LAVH has similar results in terms of surgical outcomes and complications.
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Affiliation(s)
- Y-S Choi
- Her Women's Clinic, Kwang-Ju, South Korea.
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Li M, Han Y, Feng YC. Single-port laparoscopic hysterectomy versus conventional laparoscopic hysterectomy: a prospective randomized trial. J Int Med Res 2012; 40:701-8. [PMID: 22613433 DOI: 10.1177/147323001204000234] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To compare transumbilical single-port laparoscopic hysterectomy (TSPLH) with traditional four-port total laparoscopic hysterectomy (TLH). METHODS Patients with benign uterine disease were assigned to receive either TSPLH (n = 52) or TLH (n = 56). Duration of surgery, intraoperative blood loss, conversion rate, time to first flatus, duration of immobilization, post operative analgesia requirement, port site infection, port hernia, duration of hospital stay, postoperative fever rate and percentage patient satisfaction were recorded. RESULTS TSPLH and TLH were both performed successfully. TSPLH was associated with significantly longer duration of surgery, shorter duration of immobilization, lower rate of port site infection and higher patient satisfaction than TLH. There were no other significant differences between the two groups. All subjects recovered fully and no postoperative complications occurred during a 6-month (minimum) follow-up period. CONCLUSIONS TSPLH was found to be a feasible and safe approach for laparoscopic hysterectomy.
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Affiliation(s)
- M Li
- Department of Minimally Invasive Gynaecology, Central Hospital of Fengxian District, Shanghai, China
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Chern BSM, Lakhotia S, Khoo CK, Siow AYM. Single incision laparoscopic surgery in gynecology: Evolution, current trends, and future perspectives. Gynecol Minim Invasive Ther 2012. [DOI: 10.1016/j.gmit.2012.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Single-port access laparoscopy-assisted vaginal hysterectomy: our initial experiences with 100 cases. Minim Invasive Surg 2012; 2012:543627. [PMID: 22988497 PMCID: PMC3440953 DOI: 10.1155/2012/543627] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 07/29/2012] [Indexed: 01/18/2023] Open
Abstract
Objectives. To present our initial experiences with laparoscopically assisted vaginal hysterectomy performed using homemade transumbilical single-port system. Materials and Methods. We reviewed the medical records of one hundred patients who underwent single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH). SPA-LAVH was performed with homemade single port system and conventional rigid laparoscopic instruments. Results. All procedures were successfully completed through the single-port system and vagina without need for extraumbilical puncture or conversion to laparotomy. The median patient age was 48.2 ± 6.5 years. Thirty-three patients had history of past abdominopelvic surgery. The median total operative time, largest dimension of the uterus, and weight of the uterus were 73.1 ± 24.6 min, 10.5 ± 2.1 cm, and 300.8 ± 192.5 gram, respectively. The median decline in the hemoglobin from before surgery to postoperative day 1 was 1.8 ± 0.9 g/dL. Bladder injury in occurred one patient who was repaired through intraoperative laparoscopic suture. The postoperative course was uneventful in most patients except for three who had a transient paralytic ileus, five who had pelvic hematoma, but they were recovered following conservative managements. No port-related complications were noted, and the cosmetic results were excellent. Conclusions. SPA-LAVH is technically safe procedure, and the homemade single-port system offers reliable access for single-port surgery.
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Zhou YM, Wu LP, Zhao YF, Xu DH, Li B. Single-incision versus conventional laparoscopy for colorectal disease: a meta-analysis. Dig Dis Sci 2012; 57:2103-12. [PMID: 22466079 DOI: 10.1007/s10620-012-2145-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 03/16/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND Single-incision laparoscopic surgery (SILS) was developed as a novel minimally invasive surgical approach. AIMS The aim of this meta-analysis was to compare SILS and conventional laparoscopy (CL) for colorectal diseases with respect to perioperative and oncologic outcomes. METHODS An electronic search was performed to retrieve all relevant articles published in the English language between 2008 and 2012 comparing SILS and CL for colorectal diseases. The data were analyzed with fixed-effect or random-effects models using review manager version 5.0. RESULTS A total of 14 studies (one randomized controlled trial and 13 nonrandomized controlled trials) were found to be eligible and reported on 1,155 subjects, of whom 521 underwent SILS and 634 underwent CL for colorectal diseases. Concerning the perioperative outcomes, no differences were observed in conversion rate, operating time, and postoperative adverse events; however, patients who underwent SILS had lower blood loss, decreased blood transfusion requirement, shorter time to flatus, shorter hospital stay, and smaller incision. Concerning the oncologic outcomes, length of resected specimens, number of harvested lymph nodes, proximal margin, and distal margin, were comparable between two groups. CONCLUSIONS Single-incision laparoscopic surgery (SILS) is a safe, feasible, and oncological efficient alternative to CL for colorectal diseases. Further larger, multi-centred, randomised controlled trial is indicated.
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Affiliation(s)
- Yan-Ming Zhou
- Department of Hepato-Biliary-Pancreato-Vascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China.
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Current World Literature. Curr Opin Obstet Gynecol 2012; 24:265-72. [DOI: 10.1097/gco.0b013e3283564f02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Einarsson JI, Cohen SL, Puntambekar S. Orifice-assisted small-incision surgery: case series in benign and oncologic gynecology. J Minim Invasive Gynecol 2012; 19:365-8. [PMID: 22417906 DOI: 10.1016/j.jmig.2011.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 12/13/2011] [Accepted: 12/16/2011] [Indexed: 01/19/2023]
Abstract
This case series describes the feasibility of orifice-assisted small-incision surgery (OASIS), a novel technique that may incorporate benefits of single-incision and natural-orifice surgery while minimizing issues such as instrument crowding and interaction of optical access with operative instrumentation. In our multiple-site series, we included patients from a large academic medical center in the northeastern United States and a private gynecology clinic in India. Between the 2 centers, a total of 14 patients (5 with benign disease and 9 with oncologic disease) underwent the following procedures: OASIS total laparoscopic hysterectomy, laparoscopic supracervical hysterectomy, laparoscopic myomectomy, or laparoscopic radical hysterectomy with pelvic lymph node dissection. The initial 14 cases were safely completed. Oncologic clearance was consistent with specialty norms. Operating time ranged from 60 to 150 minutes, and estimated blood loss ranged from 10 to 500 mL. Detailed procedure descriptions and videos are provided. Based on preliminary case series experience, OASIS seems to be a safe and feasible addition to the advanced minimally invasive surgeons' armamentarium for both benign and oncologic cases.
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Affiliation(s)
- Jon I Einarsson
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Cho YJ, Kim ML, Lee SY, Lee HS, Kim JM, Joo KY. Laparoendoscopic single-site surgery (LESS) versus conventional laparoscopic surgery for adnexal preservation: a randomized controlled study. Int J Womens Health 2012; 4:85-91. [PMID: 22448110 PMCID: PMC3310352 DOI: 10.2147/ijwh.s29761] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the operative outcomes, postoperative pain, and subsequent convalescence after laparoendoscopic single-site surgery (LESS) or conventional laparoscopic surgery for adnexal preservation. Study design From December 2009 to September 2010, 63 patients underwent LESS (n = 33) or a conventional laparoscopic surgery (n = 30) for cyst enucleation. The overall operative outcomes including postoperative pain measurement using the visual analog scale (VAS) were evaluated (time points 6, 24, and 24 hours). The convalescence data included data obtained from questionnaires on the need for analgesics and on patient-reported time to recovery end points. Results The preoperative characteristics did not significantly differ between the two groups. The postoperative hemoglobin drop was higher in the LESS group than in the conventional laparoscopic surgery group (P = 0.048). Postoperative pain at each VAS time point, oral analgesic requirement, intramuscular analgesic requirement, and the number of days until return to work were similar in both groups. Conclusion In adnexa-preserving surgery performed in reproductive-age women, the operative outcomes, including satisfaction of the patients and convalescence after surgery, are comparable for LESS and conventional laparoscopy. LESS may be a feasible and a promising alternative method for scarless abdominal surgery in the treatment of young women with adnexal cysts
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Affiliation(s)
- Yeon Jean Cho
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Republic of Korea
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Single-port versus conventional laparoscopic salpingectomy in tubal pregnancy: a comparison of surgical outcomes. Eur J Obstet Gynecol Reprod Biol 2011; 159:190-3. [DOI: 10.1016/j.ejogrb.2011.06.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 02/22/2011] [Accepted: 06/09/2011] [Indexed: 11/24/2022]
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Koyanagi T, Motomura S. Single-incision laparoscopically assisted vaginal hysterectomy: Operative outcomes and its learning curve. Exp Ther Med 2011; 2:867-871. [PMID: 22977590 DOI: 10.3892/etm.2011.282] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 05/13/2011] [Indexed: 12/14/2022] Open
Abstract
We previously reported on single-incision laparoscopic surgery applied to laparoscopically assisted vaginal hysterectomy (LAVH) cases. We accumulated single-incision LAVH cases to evaluate this operation, including its learning curve. Since July 2009, we planned to perform single-incision LAVH in 50 cases. Operative time, estimated blood loss, weight of resected uterus and additional procedures were recorded and compared to those of conventional multiport, multi-incision LAVH. Additionally, 47 completed single-incision LAVH cases were divided into two groups; the former 24 cases and the latter 23 cases, to estimate its learning curve. Operative outcomes were statistically similar, except that more additional procedures were performed in the conventional LAVH group (27.7% in single-incision vs. 57.5% in the conventional group, P<0.01). We experienced three conversions to multiport surgery from single-incision LAVH, and no conversion case to 'open' total abdominal hysterectomy from conventional LAVH, which was not significantly different (3/50, 6% vs. 0/40, 0%, P=0.12). During the study period, operative time was significantly shortened from 73.0±17.6 min for the former 24 cases to 58.0±12.2 min for the latter 23 cases (P<0.01). There was no significant difference with respect to other operative outcomes between the two groups. Single-incision LAVH can be performed as effectively as conventional multiport LAVH with a short learning curve. We consider that single-incision LAVH may be a promising alternative method for the treatment of certain patients with uterine myomas and adenomyosis as even a less invasive gynecological operation is required without visible scars.
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Affiliation(s)
- Takahiro Koyanagi
- Department of Obstetrics and Gynecology, Yanagawa Hospital, Yanagawa, Fukuoka, Japan
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Fader AN, Levinson KL, Gunderson CC, Winder AD, Escobar PF. Laparoendoscopic single-site surgery in gynaecology: A new frontier in minimally invasive surgery. J Minim Access Surg 2011; 7:71-7. [PMID: 21197247 PMCID: PMC3002012 DOI: 10.4103/0972-9941.72387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 09/06/2010] [Indexed: 12/16/2022] Open
Abstract
UNLABELLED REVIEW OBJECTIVE: To review the recent developments and published literature on laparoendoscopic single-site (LESS) surgery in gynaecology. RECENT FINDINGS Minimally invasive surgery has become a standard of care for the treatment of many benign and malignant gynaecological conditions. Recent advances in conventional laparoscopy and robotic-assisted surgery have favorably impacted the entire spectrum of gynaecological surgery. With the goal of improving morbidity and cosmesis, continued efforts towards refinement of laparoscopic techniques have lead to minimization of size and number of ports required for these procedures. LESS surgery is a recently proposed surgical term used to describe various techniques that aim at performing laparoscopic surgery through a single, small-skin incision concealed within the umbilicus. In the last 5 years, there has been a surge in the developments in surgical technology and techniques for LESS surgery, which have resulted in a significant increase in utilisation of LESS across many surgical subspecialties. Recently published outcomes data demonstrate feasibility, safety and reproducibility for LESS in gynaecology. The contemporary LESS literature, extent of gynaecological procedures utilising these techniques and limitations of current technology will be reviewed in this manuscript. CONCLUSIONS LESS surgery represents the newest frontier in minimally invasive surgery. Comparative data and prospective trials are necessary in order to determine the clinical impact of LESS in treatment of gynaecological conditions.
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Affiliation(s)
- Amanda Nickles Fader
- Divisions of Gynecologic Oncology, Greater Baltimore Medical Center and Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Kimberly L Levinson
- Divisions of Gynecologic Oncology, Greater Baltimore Medical Center and Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Camille C Gunderson
- Divisions of Gynecologic Oncology, Greater Baltimore Medical Center and Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Abigail D Winder
- Divisions of Gynecologic Oncology, Greater Baltimore Medical Center and Johns Hopkins Medical Institutions, Baltimore, MD, USA
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