Postoperative Pain After Single-Site Versus Multiport Hysterectomy

Abstract

Background and Objectives:With advances in laparoscopic surgery, the goal of surgeons and patients is to minimize pain to allow for faster recovery and return to normal daily activities. One of these advances is single-site surgery. In this study, we compared postoperative pain in laparoendoscopic single-site surgery (LESS) to that in traditional multiple-incision hysterectomy.Methods:Seventy patients were selected for this prospective cohort study, with 35 undergoing multiple-incision and 35 undergoing LESS hysterectomy. All patients were included who were undergoing hysterectomy with the primary surgeon. All multiport hysterectomies were performed laparoscopically. Six patients underwent LESS hysterectomy and 29 underwent robotic single-site surgery (rLESS). Patients recorded pain levels for 3 weeks after surgery on a variety of measures, including overall and incisional pain. Linear mixed effects models for repeated measures were used for all multivariate analyses, with an unstructured covariance matrix accounting for correlation between time points.Results:Overall, across all time points, there was an average reduction in pain by 1.26 (SD 0.69) points in the single-site group (P = .06). Days 3 and 14 had a marginally significant reduction in pain (P = .06 and 0.058, respectively). On days 4 and 7 there was a significant reduction in overall pain (P = .04 and .04, respectively).Conclusion:Based on the results, it is likely that single-site hysterectomy leads to less postoperative pain and achieves a lower pain score faster than multiport surgery. A randomized control trial is necessary to confirm these results before accepting them in clinical practice.

Meta-analysis of Laparoendoscopic Single-site and Vaginal Natural Orifice Transluminal Endoscopic Hysterectomy Compared with Multiport Hysterectomy: Real Benefits or Diminishing Returns?

“…Prior meta-analyses similarly showed reduction in pain scores favoring LESS, but only at some of the time points studied [22,26]. However, not all studies show a reduction in pain scores with LESS.…”

“…Prior studies have reviewed the proposed benefits of a vNOTES approach including better visualization of pelvic structures compared to traditional vaginal procedures, lower pain scores, and improved cosmesis, owing to the lack of an abdominal incision [8,9]. However, many of these studies have small sample sizes and are limited in their generalizability with data derived from a single institution [26][27][28][29][30][31][32][33]. We sought to systematically review the current literature to compare the safety and efficacy of conventional multiport laparoscopic (MPL) hysterectomy both to LESS and vNOTES approaches to determine if one approach is associated with improved patient outcomes, within a larger, more heterogeneous sample of patients.…”

Single‐incision laparoscopic abdominal cerclage placement: A retrospective study of single‐port and robotic single‐port versus multiport laparoscopy

“…In SILS, a single transumbilical incision is closed to create a scarless cosmetic appearance . Findings from a prospective cohort study of postoperative pain in SILS and multiport surgery performed by our team showed a significant decrease in overall pain with SILS along with a decrease in overall use of pain medication.…”

Laparoendoscopic Single-Site Surgery for Management of Heterotopic Pregnancy: A Case Report and Review of Literature

“…Removal of the ectopic pregnancy is done laparoscopically if the patient is hemodynamically stable. LESS has become a viable option, as only it requires only one incision which leads to fewer surgical complications such as bleeding, infection, postoperative pain [ 27 , 28 ], and hospital stay.…”