Comparison of Transvaginal and Transumbilical Laparoscopic Single-Site Surgery for Ovarian Cysts

Abstract

Background: Minimally invasive surgery is currently a preferred treatment for symptomatic ovarian cyst(s), with single-site techniques, such as transumbilical laparoendoscopic single-site surgery (TU-LESS) and transvaginal laparoendoscopic single-site surgery (TV-LESS), gaining increasing popularity. Although both methods have delivered positive outcomes, there is currently limited literature directly comparing TU-LESS and TV-LESS.Objectives: This study had two primary objectives: (1) to evaluate the safety and feasibility of TV-LESS and TU-LESS for the treatment of ovarian cysts and (2) to compare the surgical and postoperative outcomes of the two procedures.Method: This was a prospective observational clinical analysis of 81 patients with a diagnosis of benign ovarian cyst with indication for TV-LESS or TU-LESS. Surgeries were performed at a tertiary hospital between February 1, 2018 and January 31, 2020. Patients were divided into TV-LESS (n = 40) and TU-LESS groups (n = 40), with one excluded due to severe pelvic adhesive disease. Demographics, operation outcomes, and follow-up details were compared.Results: All 80 patients underwent uncomplicated procedures. The two groups were demographically matched (except age), with no difference in operation time, intraoperative blood loss, hemoglobin loss, and hospitalization costs (P > 0.05). However, TV-LESS patients had significantly faster time to ambulation (P < 0.001), faster time to return of bowel function (P < 0.001), less postoperative pain level (P < 0.001), and shorter length of hospital stay (P < 0.001). The cosmetic scores at 1, 4, and 24 weeks after surgery were also higher for the TV-LESS group. Conclusion:Our preliminary experience suggested that TU-LESS and TV-LESS are both feasible and safe for ovarian cystectomy and salpingo-oophorectomy. However, TV-LESS may provide three main advantages including:(1) fewer postoperative complications (i.e. incisional hernia); (2) less postoperative pain; and (3) improved cosmetic satisfaction.

Comparing outcomes of ovarian cystectomy by vaginal natural orifice transluminal endoscopic surgery versus laparoendoscopic single-site surgery: A retrospective cohort study

“…3,21 However, a previous study did not find a difference in surgical time between vNOTES and LESS. 22 In agreement with previous studies, our study also found that the vNOTES OC had a shorter surgical time than LESS.…”

“…19 Another study did not find a difference in blood loss between NOTES and LESS. 3,22 However, our study showed less blood loss in vNOTES than in LESS.…”

“…Previous studies reported no conversion in the vNOTES or LESS groups. 3,18,21,22 In our study, no conversion was observed in the vNOTES group, but four were observed in the LESS group and were switched to multiport laparoscopic surgery. The cause of the conversion in our study was mainly due to severe pelvic adhesions.…”

“…Although vNOTES has been reported to have more advantages than LESS, more studies are still needed to verify that claim. 3,21,22 Therefore, our study aims to assess the safety, feasibility, advantages, and disadvantages of vNOTES vs LESS in ovarian cystectomy (OC). We retrospectively analyzed the data of patients who underwent OC by either vNOTES or LESS due to benign ovarian cysts.…”

Analysis of Clinical Efficacy of Laparoendoscopic Single-Site Surgery for Uterine Fibroids

“…However, with the deepening of the concept of minimally invasive surgery, many young patients are not only satisfied with retaining fertility, but also pursuing cosmetic needs [ 5 ]. Today, laparoendoscopic single-site myomectomy (LESS-M) is increasingly concerned, as it is less invasive than conventional three- and four-port surgery, which is conducive to patients' rapid recovery with better cosmetic effects [ 6 , 7 ]. However, there is currently a paucity of comparative studies on LESS-M and MLS-M in patients with UFs, resulting in the insufficiency of evidence-based medicine evidence for its application effect and safety in the disease.…”