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Schmitt A, Crochet P, Pivano A, Tourette C, Faust C, Baumstarck K, Agostini A. The Effects of a Laparoscopy by Single-Port Endoscopic Access in Benign Adnexal Surgery: A Randomized Controlled Trial. J Minim Invasive Gynecol 2024; 31:397-405. [PMID: 38310954 DOI: 10.1016/j.jmig.2024.01.017] [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: 06/03/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/06/2024]
Abstract
STUDY OBJECTIVE To evaluate whether laparoendoscopic single-site surgery (LESS) offers advantages over conventional laparoscopy (CL) in benign adnexal surgery. DESIGN Randomized controlled study. SETTING Gynecology-Obstetrics Unit of the University Hospital of the Conception in Marseille, France. PATIENTS Patients older than 18 years requiring ovarian cystectomy or salpingo-oophorectomy by laparoscopy for symptomatic ovarian cysts requiring benign or prophylactic surgery. INTERVENTIONS In the case of ovarian cysts, premenopausal patients typically undergo a unilateral cystectomy, whereas postmenopausal patients undergo a unilateral or bilateral salpingo-oophorectomy upon a patient's request. In cases requiring prophylactic surgery, a bilateral salpingo-oophorectomy was performed. All participants were randomly assigned to either the LESS or the CL group. MEASUREMENTS AND MAIN RESULTS Patients in both groups reported similar levels of pain at 24 hours: Simple Numerical Scale was 1.3 (standard deviation, 1.5) in the LESS group vs 1.7 (standard deviation, 1.5) in the CL group (p = .12), and there were no significant differences in postoperative pain at 2 hours, 4 hours, 6 hours, and 7 days. Furthermore, there was no difference in analgesic consumption. Regarding intraoperative criteria, the only difference was the longer operating time in the LESS group than the CL group. We also found that patients' satisfaction with their scar at 1 month may be higher with LESS than with CL. CONCLUSION There was no significant difference between the 2 techniques in postoperative pain, although the LESS technique necessitated a longer operative time than the CL technique, while providing better aesthetic result patients.
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Affiliation(s)
- Andy Schmitt
- Division of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France (Drs. Schmitt, Crochet, Pivano, Tourette, and Agostini).
| | - Patrice Crochet
- Division of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France (Drs. Schmitt, Crochet, Pivano, Tourette, and Agostini)
| | - Audrey Pivano
- Division of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France (Drs. Schmitt, Crochet, Pivano, Tourette, and Agostini)
| | - Claire Tourette
- Division of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France (Drs. Schmitt, Crochet, Pivano, Tourette, and Agostini)
| | - Cindy Faust
- Department of Public Health, Aix-Marseille University, Marseille, France (Drs. Faust and Baumstarck)
| | - Karine Baumstarck
- Department of Public Health, Aix-Marseille University, Marseille, France (Drs. Faust and Baumstarck)
| | - Aubert Agostini
- Division of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France (Drs. Schmitt, Crochet, Pivano, Tourette, and Agostini)
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He H, Li T, Cui M, Jiang Q, Jiang F, Li M, Liu Y. Effect of two different laparoscopic techniques on post-operative wound complications in patients with benign gynaecological diseases: A meta-analysis. Int Wound J 2023; 21:e14382. [PMID: 37830298 PMCID: PMC10828522 DOI: 10.1111/iwj.14382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 10/14/2023] Open
Abstract
Single-port laparoscopy (SPL) has existed for several years. This meta-analysis was conducted to evaluate the efficacy of SPL compared with conventional laparoscopy (CL) in the treatment of benign gynecologic adnexal lesions. The purpose of this meta-analysis is to evaluate the superiority of SPL versus CL in the treatment of post-operative wound pain. The study looked for English-language publications from PubMed, Embase, Cochrane Library and the Web of Science until June 2023. The main result was the visual analogue scale (VAS) after 2, 4, 6, 8, 12, 24 and 48 h after operation. The paper contains 10 related papers by means of e-search. Of these, 4 were randomized controlled trials (RCTs), while 6 were non-RCTs. The results indicated that SPL and CL were significantly different after 2, 24 and 48 h after operation. SPL had lower post-operative pain after 2 h compared with CL (MD, -0.6; 95% CI, -0.98, -0.21; p = 0.002). After the operation, SPL also had a lower incidence of post-operative pain after 24 h compared with CL (MD, -0.59; 95% CI, -1.12, -0.06; p = 0.03). And the difference in pain was at 48 h after the most significant (MD, -0.49; 95% CI, -0.75, -0.23; p = 0.0002). But after 6, 8 and 12 h after operation, there was no significant difference in the degree of pain. Thus, SPL operations may result in a lower degree of pain than CL in both the post-operative and far post-operative phase.
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Affiliation(s)
- Haining He
- Department of Gynaecology and Obstetrics, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Tinglan Li
- People's Hospital of Aba Tibetan and Qiang Autonomous PrefectureAbaChina
| | - Manman Cui
- Department of Gynaecology and Obstetrics, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Qin Jiang
- Department of Gynaecology and Obstetrics, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Fuchuan Jiang
- Department of Gynaecology and Obstetrics, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Min Li
- Department of Gynaecology and Obstetrics, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Yi Liu
- Department of Gynaecology and Obstetrics, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
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Chang CH, Ding DC. Comparing outcomes of ovarian cystectomy by vaginal natural orifice transluminal endoscopic surgery versus laparoendoscopic single-site surgery: A retrospective cohort study. J Chin Med Assoc 2023; 86:682-687. [PMID: 37185219 DOI: 10.1097/jcma.0000000000000933] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND We aimed to compare the outcomes of ovarian cystectomy (OC) performed by vaginal natural orifice transluminal endoscopic surgery (vNOTES) vs transumbilical laparoendoscopic single-site surgery (LESS). METHODS We retrospectively analyzed the data of patients in our hospital who underwent OC either by vNOTES or LESS between January 2015 and September 2021. Demographic data were collected. The primary outcome was the conversion rate. The secondary outcomes were the duration of surgery, length of hospital stay, estimated blood loss, maximum body temperature within 48 hours after operation, and duration of maximum body temperature (hours), among others. Statistical analysis was done using the SPSS software. RESULTS Exactly 284 patients were screened. The vNOTES and LESS groups consisted of 21 and 47 patients, respectively. There was no significant difference in the conversion rates between the two groups (0 vs 8.5% in vNOTES and LESS, respectively; p = 0.303). Compared with the vNOTES group, the LESS group had a larger cyst diameter (6.00 ± 2.32 vs 4.69 ± 1.29 cm; p = 0.004), more endometriotic cysts (42.6% vs 9.5%; p < 0.001), and more pelvic adhesions requiring adhesiolysis (57.4% vs 19.0%; p = 0.003). At baseline, there were no other differences between the groups. The secondary outcomes included a shorter duration of surgery (70.14 ± 27.30 vs 99.57 ± 36.26 minutes; p = 0.001) and lower estimated blood loss (64.29 ± 39.19 vs 163.43 ± 251.20 mL; p = 0.011) in the vNOTES group. Regression analysis showed the diameter of the ovarian cyst correlated with surgical time. The complication was comparable between the two groups. CONCLUSION Above all, the advantages of vNOTES include an absence of visible scars, shorter surgical duration, and less blood loss when compared with LESS. Further large-scale prospective trials should confirm the results of our study.
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Affiliation(s)
- Chi-Han Chang
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan, ROC
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan, ROC
- Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan, ROC
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Lin Y, Liu M, Ye H, He J, Chen J. Laparoendoscopic single-site surgery compared with conventional laparoscopic surgery for benign ovarian masses: a systematic review and meta-analysis. BMJ Open 2020; 10:e032331. [PMID: 32066600 PMCID: PMC7045036 DOI: 10.1136/bmjopen-2019-032331] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the safety, efficiency and preferred indication for laparoendoscopic single-site surgery (LESS) compared with conventional laparoscopic (CL) surgery for benign ovarian masses. DESIGN A systemic review and cumulative meta-analysis were performed in line with the criteria of Grading of Recommendations Assessment, Development and Evaluation: levels of evidence and grades of recommendation. DATA SOURCES We comprehensively searched the electronic databases including PubMed, Medline, Embase and the Cochrane Library in November 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included all randomised controlled trials (RCTs) and retrospective studies published in recent 10 years, which investigated the performance of LESS versus CL in patients at all ages with benign ovarian masses. RESULTS Four RCTs and nine retrospective studies published in recent decade including 1542 cases (744 cases for LESS and 798 cases for CL) were identified. Perioperative complication was consisted of intraoperative and postoperative complications, including ileus, wound infection or dehiscence and incisional hernia. Although LESS has less postoperative analgesic consumption (46.78% and 79.25%; OR: 0.49; 95% CI: 0.33 to 0.74, p<0.001) and shorter hospital stay (weighted mean difference (WMD): -0.24 days; 95% CI: -0.35 to -0.14; p<0.001), CL has less perioperative complications (6.59% and 2.85%; OR: 2.08; 95% CI: 1.05 to 4.11, p=0.04) and shorter operative time (WMD: 3.43 min; 95% CI: -0.03 to 6.88; p=0.05). Body mass index, history of previous abdominal surgery, size of adnexal mass, estimated blood loss and postoperative pain scores did not differ significantly between two techniques. CONCLUSIONS The indications of LESS for benign ovarian masses are similar to CL and it has better postoperative recovery. However, with less perioperative complications, CL surgery is safer than LESS.
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Affiliation(s)
- Yun Lin
- Department of Gynecology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Mubiao Liu
- Department of Gynecology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Haiyan Ye
- Department of Gynecology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jianhui He
- Department of Gynecology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jianguo Chen
- Department of Gynecology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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Karasu Y, Akselim B. Feasibility of single-incision laparoscopy for ruptured ectopic pregnancies with hemoperitoneum. MINIM INVASIV THER 2018; 28:46-50. [PMID: 29741420 DOI: 10.1080/13645706.2018.1470538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND The aim of this study was to compare single-incision laparoscopic surgery (SILS) and conventional laparoscopy in ectopic pregnancies accompanied by severe hemoperitoneum. MATERIAL AND METHODS The main outcome measures were duration of surgery, intraoperative bleeding quantity, complications, post-operative pain scores, additional analgesic requirements, and length of hospital stay. RESULTS A total of 53 women, 28 in the conventional laparoscopy group and 25 in the SILS group, participated in the study. There were no differences in demographic characteristics between the two groups. There were no differences in terms of variables including gestational week, beta human chorionic gonadotropin (βhCG) levels, and operation time. No intraoperative complications were observed in either group. The groups exhibited no significant differences regarding additional analgesic requirements or postoperative pain scores. However, pain at the sixth postoperative hour was lower in the SILS group. This effect was not observed at 12 and 24 hours. CONCLUSION SILS appears to be effective and safe for the treatment of ruptured ectopic pregnancies accompanied by hemoperitoneum.
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Affiliation(s)
- Yetkin Karasu
- a Obstetrics and Gynecology , Ankara Training and Research Hospital , Ankara , Turkey
| | - Burak Akselim
- a Obstetrics and Gynecology , Ankara Training and Research Hospital , Ankara , Turkey
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Single port laparoscopy (SPL): Retrospective study evaluating postoperative pain in comparison with conventional laparoscopy (CL). J Gynecol Obstet Hum Reprod 2018; 47:365-369. [PMID: 29654938 DOI: 10.1016/j.jogoh.2018.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/03/2018] [Accepted: 04/10/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare postoperative pain after single port laparoscopy (SPL) approach with conventional laparoscopy (CL) in case of adnexectomy. MATERIAL AND METHODS This is a retrospective monocentric study involving patients who underwent adnexal surgery by SPL or CL for a suspected benign disease or as a preventive measure. The main outcome measure was the level of postoperative pain. RESULTS A total of 87 patients were enrolled. Within 2h, the numerical scale (NS) was 1.9 in SPL group and 2.0 in the CL group (P=0.85). The next day, the NS was 1.8 in SPL group and 1.5 in CL group (P=0.55). The operating time was significantly shorter in SPL group (33 versus 56min, 95% CI [-31; -15], P<0.001) and no rupture of ovarian cysts occurred in this group. There was no significant difference concerning complications, length of hospital stay, general satisfaction and POSAS (Patient and Observer Scar Assessment Scale) score. CONCLUSION This study confirms the feasibility of single-port laparoscopic adnexectomy. We have not shown significant difference in postoperative pain but the operating time was significantly reduced under the guise of an experienced surgeon.
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Schmitt A, Crochet P, Baumstark K, Tourette C, Poizac S, Pivano A, Boubli L, Cravello L, Agostini A. Effect of laparoscopy by single-port endoscopic access in benign adnexal surgery: study protocol for a randomized controlled trial. Trials 2018; 19:38. [PMID: 29335017 PMCID: PMC5769507 DOI: 10.1186/s13063-017-2429-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/08/2017] [Indexed: 11/17/2022] Open
Abstract
Background Laparoscopic surgery has become the preferred surgical approach due to a reduction in postoperative pain, better recovery, shorter hospitalization, and improved esthetic outcomes. Laparoscopic surgery with single-port laparoscopy (SPL) is a laparoscopic surgery technique that is based on making a single parietal incision using a single trocar specifically designed to allow introduction of several instruments. The level of evidence regarding the advantages of SPL in terms of postoperative pain has remained low despite several randomized studies. Adult patients exhibiting a surgical indication for an a priori benign ovarian pathology or for prophylactic purposes that can be performed by laparoscopy will be randomized to receive conventional laparoscopy (CL) or SPL. The aim of our study is to evaluate whether SPL offers advantages over CL in benign adnexal surgery. Methods The patients will be evaluated preoperatively to confirm their eligibility. The perioperative data up to 24 h after the intervention, as well as the postoperative data at day 7 and at one month from the intervention will be collected. The primary outcome for the study will be the postoperative pain at 24 h ± 2 h after the intervention. The pain will be assessed by a numeric rating scale of 0–10. Other outcomes will also be assessed, such as pain at other times, the consumption of analgesics, the operative time, perioperative bleeding, the number of additional trocars in the two groups, the incidence of laparoconversion, the esthetic criteria of the scar at one month, the incidence of complications, and the quality of life at one month. Discussion If our hypothesis is confirmed, this study will provide evidence that the use of SPL can decrease postoperative pain in adnexal surgery. The standard surgical treatment of this condition would thus be modified. Trial registration ClinicalTrials.gov, NCT02739724. Registered on 12 April 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2429-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andy Schmitt
- Pôle de gynécologie-obstétrique et reproduction, Gynepôle, AP-HM Hôpital de la Conception, 147 bd Baille, 13005, Marseille, France
| | - Patrice Crochet
- Pôle de gynécologie-obstétrique et reproduction, Gynepôle, AP-HM Hôpital de la Conception, 147 bd Baille, 13005, Marseille, France
| | - Karine Baumstark
- Clinical Research Platform, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Claire Tourette
- Pôle de gynécologie-obstétrique et reproduction, Gynepôle, AP-HM Hôpital de la Conception, 147 bd Baille, 13005, Marseille, France
| | - Sabine Poizac
- Pôle de gynécologie-obstétrique et reproduction, Gynepôle, AP-HM Hôpital de la Conception, 147 bd Baille, 13005, Marseille, France
| | - Audrey Pivano
- Pôle de gynécologie-obstétrique et reproduction, Gynepôle, AP-HM Hôpital de la Conception, 147 bd Baille, 13005, Marseille, France
| | - Léon Boubli
- Pôle de gynécologie-obstétrique et reproduction, Gynepôle, AP-HM Hôpital de la Conception, 147 bd Baille, 13005, Marseille, France
| | - Ludovic Cravello
- Pôle de gynécologie-obstétrique et reproduction, Gynepôle, AP-HM Hôpital de la Conception, 147 bd Baille, 13005, Marseille, France
| | - Aubert Agostini
- Pôle de gynécologie-obstétrique et reproduction, Gynepôle, AP-HM Hôpital de la Conception, 147 bd Baille, 13005, Marseille, France.
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Single-Port Laparoscopy vs Conventional Laparoscopy in Benign Adnexal Diseases: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2017; 24:1083-1095. [DOI: 10.1016/j.jmig.2017.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/26/2017] [Accepted: 07/03/2017] [Indexed: 12/20/2022]
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Balusamy S, Salgaonkar HP, Behera RR, Bhalerao-Gandhi A, Bhandarkar DS. Laparoendoscopic single-site adnexal surgery: Preliminary Indian experience. J Minim Access Surg 2017; 13:170-175. [PMID: 28607282 PMCID: PMC5485804 DOI: 10.4103/jmas.jmas_206_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION: Laparoendoscopic single-site surgery (LESS) is an emerging technique in gynaecology. The proposed advantages of the LESS include better cosmesis and reduction in pain. We report our preliminary experience with LESS in the treatment of adnexal pathology. MATERIALS AND METHODS: After a preoperative workup, LESS was offered to 37 patients between July 2009 and April 2015. All the procedures were carried out through a 2–2.5 cm transumbilical incision using conventional laparoscopic instruments. A single-incision, multiport (SIMP) approach (utilising one 7 mm and two 5 mm ports) was used in 27 patients and a homemade glove port (HMGP) was utilised in ten patients. All the specimens were extracted after placement in a plastic bag or inside the glove port avoiding contact with the wound. Umbilical fascial incisions were meticulously closed with non-absorbable sutures. RESULTS: Two patients with a history of previous abdominal surgery required omental adhesiolysis. Seventeen patients with breast cancer underwent bilateral salpingo-oophorectomy, ten had ovarian cystectomy (6 had cystadenoma, 2 had endometriotic cysts and 2 had dermoid cyst), six had excision of paraovarian cysts (one along with partial salpingectomy) and four with ruptured ectopic pregnancy underwent salpingectomy. LESS was completed in all but one patient, who required insertion of an additional 5 mm port. There were no intra- or post-operative complications. CONCLUSIONS: Our experience confirms the feasibility and safety of LESS in a variety of benign adnexal pathology. Both the SIMP and HMGP approaches seem comparable. Performing LESS without the use of specialised access ports or instruments makes it cost effective and suitable for wider application.
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Affiliation(s)
- Smitha Balusamy
- Department of Obstetrics and Gynecology, Rockland Hospital, Dwarka, New Delhi, India
| | | | - Ramya Ranjan Behera
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
| | | | - Deepraj S Bhandarkar
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
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Karasu Y, Akselim B, Kavak Cömert D, Ergün Y, Ülker K. Comparison of single-incision and conventional laparoscopic surgery for benign adnexal masses. MINIM INVASIV THER 2017; 26:278-283. [PMID: 28290726 DOI: 10.1080/13645706.2017.1299763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Our aim was to compare single incision and conventional laparoscopic surgeries performed for benign adnexal masses with regard to their intraoperative characteristics and postoperative pain levels. MATERIAL AND METHODS The main outcome measures were laparoscopic entry time, total operation time, amount of bleeding, intraoperative complications, post-operative pain scores, additional analgesic requirements, and length of hospital stay. RESULTS A total of 71 women, 39 in the conventional laparoscopy group and 32 in the SILS group, participated in the study. Demographic findings did not differ between the two groups. Similarly, rates of intraoperative complications, rates of conversion to laparotomy, pre- and postoperative hematocrit levels were not significantly different between the groups. Laparoscopic entry time was shorter in the SILS group (10.4 ± 5.9 min. vs. 5.28 ± 1.7 min.). However, total operation time was similar in the two groups. The groups did not show significant differences regarding additional analgesic requirements, or postoperative pain scores after 24 h. However, pain scores in the recovery room and after six and 12 h were lower in the SILS group. CONCLUSION SILS seems to be effective and safe for the treatment of benign adnexal masses. SILS appears to be advantageous regarding postoperative pain especially in the early period.
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Affiliation(s)
- Yetkin Karasu
- a Obstetrics and Gynecology , Ankara Training and Research Hospital , Ankara , Turkey
| | - Burak Akselim
- a Obstetrics and Gynecology , Ankara Training and Research Hospital , Ankara , Turkey
| | - Duygu Kavak Cömert
- a Obstetrics and Gynecology , Ankara Training and Research Hospital , Ankara , Turkey
| | - Yusuf Ergün
- a Obstetrics and Gynecology , Ankara Training and Research Hospital , Ankara , Turkey
| | - Kahraman Ülker
- b Obstetrics and Gynecology , Memorial Şişli Hospital , İstanbul , Turkey
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Suh KJ, Kim SH, Lee KH, Kim TY, Kim YJ, Han SW, Kang E, Kim EK, Kim K, No JH, Han W, Noh DY, Lee M, Kim HS, Im SA, Kim JH. Bilateral Salpingo-oophorectomy Compared to Gonadotropin-Releasing Hormone Agonists in Premenopausal Hormone Receptor-Positive Metastatic Breast Cancer Patients Treated with Aromatase Inhibitors. Cancer Res Treat 2017; 49:1153-1163. [PMID: 28253566 PMCID: PMC5654164 DOI: 10.4143/crt.2016.463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 02/01/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose Although combining aromatase inhibitors (AI) with gonadotropin-releasing hormone agonists (GnRHa) is becoming more common, it is still not clear if GnRHa is as effective as bilateral salpingo-oophorectomy (BSO). Materials and Methods We retrospectively analyzed data of 66 premenopausal patients with hormone receptor– positive, human epidermal growth factor receptor 2–negative recurrent and metastatic breast cancer who had been treated with AIs in combination with GnRHa or BSO between 2002 and 2015. Results The median patient age was 44 years. Overall, 24 (36%) received BSO and 42 (64%) received GnRHa. The clinical benefit rate was higher in the BSO group than in the GnRHa group (88% vs. 69%, p=0.092). Median progression-free survival (PFS) was longer in the BSO group, although statistical significance was not reached (17.2 months vs. 13.3 months, p=0.245). When propensity score matching was performed, the median PFS was 17.2 months for the BSO group and 8.2 months for the GnRHa group (p=0.137). Multivariate analyses revealed that the luminal B subtype (hazard ratio, 1.67; 95% confidence interval [CI], 1.08 to 2.60; p=0.022) and later-line treatment (≥ third line vs. first line; hazard ratio, 3.24; 95% CI, 1.59 to 6.59; p=0.001) were independent predictive factors for a shorter PFS. Incomplete ovarian suppression was observed in a subset of GnRHa-treated patients whose disease showed progression, with E2 levels higher than 21 pg/mL. Conclusion Both BSO and GnRHa were found to be effective in our AI-treated premenopausal metastatic breast cancer patient cohort. However, further studies in larger populations are needed to determine if BSO is superior to GnRHa.
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Affiliation(s)
- Koung Jin Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sae-Won Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Eunyoung Kang
- Department of Surgery and Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun-Kyu Kim
- Department of Surgery and Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kidong Kim
- Department of 5Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Wonshik Han
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery and Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Young Noh
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery and Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Seung Kim
- Department of Surgery and Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Pontis A, Sedda F, Mereu L, Podda M, Melis GB, Pisanu A, Angioni S. Review and meta-analysis of prospective randomized controlled trials (RCTs) comparing laparo-endoscopic single site and multiport laparoscopy in gynecologic operative procedures. Arch Gynecol Obstet 2016; 294:567-77. [DOI: 10.1007/s00404-016-4108-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/22/2016] [Indexed: 12/31/2022]
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Al-Badawi IA, AlOmar O, Albadawi N, Abu-Zaid A. Single-port laparoscopic surgery for benign salpingo-ovarian pathology: a single-center experience from Saudi Arabia. Ann Saudi Med 2016; 36:64-9. [PMID: 26809202 PMCID: PMC6074270 DOI: 10.5144/0256-4947.2016.26.1.1200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are limited data and few solid conclusions on the use of single-port laparoscopic surgery (SPLS) in gynecologic procedures. OBJECTIVE The objective of our descriptive study was to review our single-center experience with benign salpingo-ovarian conditions (feasibility, safety and surgical outcomes). DESIGN A retrospective cross-sectional study from January-2012 to October-2014. SETTING King Faisal Specialist Hospital & Research Center--a referral tertiary healthcare center. PATIENTS AND METHODS All gynecologic patients who underwent SPLS procedures for benign adnexal pathologies were analyzed for pre-, intra-and postoperative details. SPLS was done using a single multi-port trocar and standard laparoscopic instruments. MAIN OUTCOME MEASURES Perioperative complications and conversion rate. RESULTS Eighty (n=80) patients underwent SPLS interventions. the median age and BMi were 37 years and 24.6 kg/m2, respectively. Thirty-one patients (38.8%) had >=1 previous abdominopelvic surgeries. Of 104 SPLS procedures conducted, the three most common procedures were unilateral ovarian cystectomy (n=21/104; 20.2%), bilateral ovarian transposition (n=20/104; 19.2%), and unilateral salpingo-oophorectomy (n=16/104; 15.4%). No patient required addition of extra ports or conversion to conventional multi-port laparoscopy or laparotomy. The median operative time, estimated blood loss and hospital stay were 66 min, 10 mL and 1 day, respectively. No patient experienced major intraoperative or postoperative complications. the median postoperative pain grade using the visual analogue scale was 2 (examined in 74 of 80 patients). At six-weeks postoperatively, the median wound scar length (measured at outpatient clinic) was 1.2 cm. CONCLUSION SPLS in the management of benign salpingo-ovarian conditions is generally feasible, potentially safe, and associated with satisfactory operative and postoperative outcomes. LIMITATIONS Retrospective and non-comparative design. Single-center experience. Subjective scores of the patients' self-reported satisfaction about post-operative pain, subject to recall bias.
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Affiliation(s)
- Ismail A Al-Badawi
- Dr. ismail A. Al-Badawi, Department of Obstetrics and Gynecology,, King Faisal Specialist Hospital and Research Centre,, PO Box 3354 Riyadh 11211, Saudi Arabia, T: +966-011-442-7392, F: +966-011-442-7393,
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Song T, Park JY, Kim TJ, Lee YY, Choi CH, Lee JW, Bae DS, Kim BG. A prospective comparative study of cosmetic satisfaction for three different surgical approaches. Eur J Obstet Gynecol Reprod Biol 2015; 190:48-51. [PMID: 25978858 DOI: 10.1016/j.ejogrb.2015.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 04/17/2015] [Accepted: 04/22/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To compare gynecologic patients' cosmetic satisfaction with surgical wounds after different approaches: laparoendoscopic single-site surgery (LESS), conventional laparoscopic surgery (CLS) and open surgery (OS). STUDY DESIGN This was a prospective study. The primary outcome was the cosmetic satisfaction after LESS, CLS, or OS, measured at 1 and 6 months post-surgery using the well-validated Cosmetic Scale. Multiple linear regression analysis was used to determine whether the surgical approach was independently associated with cosmetic satisfaction or not. RESULTS Of 294 patients enrolled, 84 (28.6%), 129 (43.9%), and 81 patients (27.3%) underwent LESS, CLS, and OS, respectively. Cosmetic Scale scores in the LESS group at 1 month post-surgery was about 7 higher than in the CLS group and 9 higher than in the OS group (P<0.001). This difference was maintained also at 6 months post-surgery (P<0.001). On multiple linear regression analysis, the surgical approach was independently associated with postoperative cosmetic satisfaction (P<0.001). CONCLUSION Our study found that cosmetic satisfaction after LESS was highest, followed by CLS, then OS. Therefore, physicians should more assertively discuss and consider LESS for gynecologic diseases.
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Affiliation(s)
- Taejong Song
- Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Young Park
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae-Joong Kim
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Yoo-Young Lee
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chel Hun Choi
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong-Won Lee
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Duk-Soo Bae
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byoung-Gie Kim
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Santos Filho AS, Noviello MB, Damasceno RCF, Patrício EDC, Félix LR, Giostri PG, Brandão AHF. Single-site laparoscopy in gynecology: preliminary study of a series of 50 cases. Rev Assoc Med Bras (1992) 2015; 60:548-54. [PMID: 25650855 DOI: 10.1590/1806-9282.60.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 05/22/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to describe the initial experience of a gynecology team, at a tertiary care center, when performing single-port laparoscopic surgery. METHODS this is a retrospective study reviewing the medical records of 50 patients treated at the outpatient gynecology clinic of our institution between June 2012 and July 2013 who underwent single-port laparoscopic surgery. This study was approved by the institution's Ethics in Research Committee. RESULTS the mean age of patients is 37.8 years, ranging from 18 to 70 years, and the most frequent surgical indications were adnexal mass (72%) and chronic pelvic pain (24%). The mean operative time was 94.4 minutes with a mean hospital stay of 25.8 hours. There were no perioperative complications. We recorded two conversions to laparotomy due to technical difficulties during the procedure. All cases of conversion had pelvic adhesions. All operative complications were successfully treated and none were considered severe. CONCLUSION this is one of the largest case series in the literature regarding surgical treatment by single-port laparoscopy in gynecology and presents evidence on reduction of surgical morbidity and satisfactory cosmetic results. We conclude that single-port laparoscopy is a viable minimally invasive technique, and that it contributes to the construction of a new scenario in modern gynecological surgery.
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Barbed Suture vs Traditional Suture in Single-Port Total Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2014; 21:825-9. [DOI: 10.1016/j.jmig.2014.03.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 03/04/2014] [Accepted: 03/13/2014] [Indexed: 12/16/2022]
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Song T, Kim MK, Kim ML, Yoon BS, Seong SJ. Would Fewer Port Numbers in Laparoscopy Produce Better Cosmesis? Prospective Study. J Minim Invasive Gynecol 2014; 21:68-73. [DOI: 10.1016/j.jmig.2013.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 06/30/2013] [Accepted: 07/02/2013] [Indexed: 10/26/2022]
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Borghese B, Marzouk P, Santulli P, de Ziegler D, Chapron C. Traitements chirurgicaux des tumeurs ovariennes présumées bénignes. ACTA ACUST UNITED AC 2013; 42:786-93. [DOI: 10.1016/j.jgyn.2013.09.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vonk Noordegraaf A, Anema JR, Louwerse MD, Heymans MW, van Mechelen W, Brölmann HAM, Huirne JAF. Prediction of time to return to work after gynaecological surgery: a prospective cohort study in the Netherlands. BJOG 2013; 121:487-97. [PMID: 24245993 DOI: 10.1111/1471-0528.12494] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To measure the impact of the level of invasiveness of gynaecological procedures on time to full Return to Work (RTW) and to identify the most important preoperative sociodemographic, medical and work-related factors that predict the risk of prolonged sick leave. DESIGN Prospective cohort study. SETTING Dutch university hospital. POPULATION A total of 148 women aged 18-65 years scheduled for gynaecological surgery for benign indications. METHODS A questionnaire regarding the surgical procedure as well as perioperative and postoperative complications was completed by the attending resident at baseline and 6 weeks after surgery. All other outcome measures were assessed using self-reported patient questionnaires at baseline and 12 weeks post-surgery. The follow-up period was extended up to 1 year after surgery in women failing to return to work. Surgical procedures were categorised into diagnostic, minor, intermediate and major surgery. MAIN OUTCOME MEASURES Time to RTW and important predictors for prolonged sick leave after surgery. RESULTS Median time to RTW was 7 days (interquartile range [IQR] 5-14) for diagnostic surgery, 14 days (IQR 9-28) for minor surgery, 60 days (IQR 28-101) for intermediate surgery and 69 days (IQR 56-135) for major surgery. Multivariable analysis showed a strongest predictive value of RTW 1 year after surgery for level of invasiveness of surgery (minor surgery hazard ratio [HR] 0.51, 95% CI 0.32-0.81; intermediate surgery HR 0.20, 95% CI 0.12-0.34; major surgery HR 0.09, 95% CI 0.06-0.16), RTW expectations before surgery (HR 0.55, 95% CI 0.36-0.84), and preoperative functional status (HR 1.09, 95% CI 1.04-1.13). A prediction model regarding the probability of prolonged sick leave at 6 weeks was developed, with a sensitivity of 89% and a specificity of 86%. CONCLUSIONS RTW often takes a long time, especially after intermediate and major surgery. This study reveals important predictors for prolonged sick leave and provides a prediction model for the risk of sick leave extending 6 weeks after benign gynaecological surgery in the Netherlands.
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Affiliation(s)
- A Vonk Noordegraaf
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
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Laparoendoscopic single-site versus conventional laparoscopic gynecologic surgery: a metaanalysis of randomized controlled trials. Am J Obstet Gynecol 2013; 209:317.e1-9. [PMID: 23860211 DOI: 10.1016/j.ajog.2013.07.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 06/03/2013] [Accepted: 07/01/2013] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the current evidence regarding the efficiency, safety, and potential advantages of laparoendoscopic single-site surgery (LESS) for treating gynecologic diseases. STUDY DESIGN We comprehensively searched PubMed, Embase, and the Cochrane Library from their inception to December 2012. Two authors screened out duplicates and independently reviewed eligibility of each study. We included randomized controlled trials comparing LESS with conventional laparoscopy (CL) for treating gynecologic diseases. The primary outcomes were perioperative complication rate, conversion rate, postoperative pain, and cosmetic satisfaction. RESULTS We included 6 randomized controlled trials with 439 participants in the final analysis. There were no significant differences between LESS and CL in terms of perioperative complication rate (15.5% and 14.3%; risk ratio, 1.11; 95% confidence interval [CI], 0.74-1.67; P = .61), conversion rate (3.8% and 1.1%; risk ratio, 2.75; 95% CI, 0.73-10.33; P = .13), postoperative pain (weighted mean difference [WMD], -0.22; 95% CI, -1.29 to 0.85; P = .68), analgesic requirement (WMD, 0.41; 95% CI, -1.69 to 2.51; P = .70), and cosmetic satisfaction (WMD, 0.19; 95% CI, -0.30 to 0.68; P = .46). There were also no differences in terms of operative time (P = .65), hemoglobin change (P = .23), time to first flatus (P = .17), and length of hospital stay (P = .99) between both techniques. CONCLUSION This metaanalysis provides evidence that LESS is comparable in the efficacy and safety, but does not offer potential advantage such as better cosmesis and lesser pain compared with CL for treating gynecologic diseases.
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Laparoendoscopic single-site versus conventional laparoscopic total extraperitoneal hernia repair: a prospective randomized clinical trial. Surg Endosc 2013; 27:4684-92. [DOI: 10.1007/s00464-013-3116-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 07/17/2013] [Indexed: 11/27/2022]
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Ichikawa M, Ono S, Mine K, Akira S. Changing our view of minimally invasive gynecologic surgery: a review of laparoendoscopic single-site surgery and a report on new approaches. Asian J Endosc Surg 2013; 6:151-7. [PMID: 23741981 DOI: 10.1111/ases.12041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 03/07/2013] [Accepted: 04/07/2013] [Indexed: 01/18/2023]
Abstract
The recent emergence of laparoendoscopic single-site surgery (LESS) has had a great impact on gynecology. As LESS grows in popularity, attention has been paid to the procedure's cosmetic benefits. Although in theory LESS is an ideal approach that leaves no visible scars and improves patients' quality of life, the outcomes are not always ideal according to recently published data. Therefore, alternative approaches, such as mini-laparoscopy, are also becoming more popular. Herein, we review randomized trials studying the benefits of LESS in gynecology and discuss alternative approaches. Finally, we propose the mimic approach as the next generation for non-visible scar surgery.
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Affiliation(s)
- Masao Ichikawa
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan.
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Single-incision laparoscopy in gynecologic surgery: a systematic review and meta-analysis. Obstet Gynecol 2013; 121:819-828. [PMID: 23635683 DOI: 10.1097/aog.0b013e318288828c] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate surgical outcomes for gynecologic surgery performed by single-incision laparoscopy compared with conventional multi-incision laparoscopy. DATA SOURCES We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and clinicaltrials.gov through August 2012. We also screened reference lists of retrieved articles and manually searched abstracts from conference proceedings. METHODS OF STUDY SELECTION We included randomized control trials (RCTs) and high-quality observational studies that compared outcomes for single-incision laparoscopy and conventional laparoscopy for gynecologic surgery in patients. Included studies met predefined quality criteria and reported, at minimum, on complications, conversions, and operative time. TABULATION, INTEGRATION, RESULTS: Six RCTs and 15 observational studies met inclusion criteria, with a total of 2,085 patients (899 single-incision laparoscopies and 1,186 conventional laparoscopies). In the pooled analysis, there was no significant difference in the risk of total complications between single-incision laparoscopy and conventional laparoscopy groups (relative risk 1.01, 95% confidence interval [CI] 0.72-1.40; P=.97, random effects model). The meta-analysis was powered to detect a 5% difference in complications (power=0.8, alpha=0.05). Mean operative time for adnexal surgery performed by single-incision laparoscopy was 6.97 minutes longer than conventional laparoscopy (95% CI 0.16-13.77; P=.045; I=47.2; random effects based on three RCTs). There was no significant difference in mean operative time for hysterectomy procedures performed by single-incision laparoscopy (8.29 minutes, 95% CI -5.85 to 22.43; P=.251; I=83.6; random effects based on three RCTs). Clinical outcomes of postoperative pain, change in hemoglobin, length of hospital stay, and scar cosmesis could not be pooled because of paucity of data and lack of uniform reporting. CONCLUSION There was no difference in the risk of complications between single-incision laparoscopy and conventional laparoscopy approaches in gynecologic surgery. Studies with imprecise effect sizes suggest that single-incision laparoscopy may have longer operative time for adnexal surgery, but not for hysterectomy. Effects on other surgical outcomes remain uncertain.
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Mencaglia L, Mereu L, Carri G, Arena I, Khalifa H, Tateo S, Angioni S. Single port entry – Are there any advantages? Best Pract Res Clin Obstet Gynaecol 2013; 27:441-55. [DOI: 10.1016/j.bpobgyn.2012.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 12/06/2012] [Indexed: 12/11/2022]
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Song T, Cho J, Kim TJ, Kim IR, Hahm TS, Kim BG, Bae DS. Cosmetic outcomes of laparoendoscopic single-site hysterectomy compared with multi-port surgery: randomized controlled trial. J Minim Invasive Gynecol 2013; 20:460-7. [PMID: 23541248 DOI: 10.1016/j.jmig.2013.01.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 01/12/2013] [Accepted: 01/14/2013] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To compare cosmetic satisfaction with laparoendoscopic single-site surgery (LESS) compared with multi-port surgery. DESIGN Randomized controlled trial (Canadian Task Force classification I). SETTING University hospital. PATIENTS Twenty women who underwent laparoscopically-assisted vaginal hysterectomy (LAVH) via LESS or multi-port surgery. INTERVENTIONS Laparoendoscopic single-site surgery or multi-port surgery. MEASUREMENT AND MAIN RESULTS Cosmetic satisfaction was assessed using the Body Image Questionnaire at baseline and at 1, 4, and 24 weeks after surgery. Of the 20 LESS procedures, 1 was converted to multi-port surgery because of severe adhesions, and 1 woman assigned to undergo multi-port surgery was lost to follow-up. The 2 surgery groups did not differ in clinical demographic data and surgical results or postoperative pain scores at 12, 24, and 36 hours. Compared with the multi-port group, the LESS group reported significantly higher cosmetic satisfaction at 1, 4, and 24 weeks after surgery (p < .01). CONCLUSION Compared with multi-port surgery, LESS is not only a feasible approach with comparable operative outcomes but also has an advantage insofar as cosmetic outcome.
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Affiliation(s)
- Taejong Song
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
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Dauser B, Görgei A, Stopfer J, Herbst F. Conventional laparoscopy vs. single port surgery from a patient’s point of view: influence of demographics and body mass index. Wien Klin Wochenschr 2012. [DOI: 10.1007/s00508-012-0299-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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