Single incision laparoscopic surgery using conventional laparoscopic instruments versus two-port laparoscopic surgery for adnexal lesions

Abstract

Single incision laparoscopic surgery (SILS) has emerged as least invasive interventions for gynecologic disease. However, SILS is slow to gain in popularity due to difficulties in triangulation and instrument crowding. Besides, the costly instruments may influence patients’ will to have this procedure, and limit other medical expense as well. To optimize outcome and reduce cost, the objective of this study is to evaluate the feasibility and safety for patients undergoing adnexal surgeries using conventional laparoscopic instruments with SILS (SILS-C), and to compare with those of patients subject to TP using conventional laparoscopic instruments (TP-C). This is a retrospective case–control study. The data dated from April 2011 to April 2018. Patients who received concomitant multiple surgeries, were diagnosed with suspected advanced stage ovarian malignancy, or required frozen sections for intraoperative pathologic diagnosis were excluded. Demographic data, including the age, body weight, height, previous abdominal surgery were obtained. The surgical outcomes were compared using conventional statistical methods. 259 patients received SILS-C. The operating time was 63.83 ± 25.31 min. Blood loss was 2.38 ± 6.09 c.c. 58 patients (24.38%) needed addition of port to complete surgery. 384 patients received TP-C. Compared with SILS-C, the operating time was shorter (57.32 ± 26.38 min, OR = 0.984, CI = 0.975–0.992). The patients were further divided into unilateral or bilateral adnexectomy, and unilateral or bilateral cystectomy. Other than the operating time in unilateral cystectomy (66.12 ± 19.5 vs. 58.27 ± 23.92 min, p = .002), no statistical differences were observed in the subgroup analysis. Single incision laparoscopic surgery using conventional laparoscopic instruments is feasible and safe as initial approach to adnexal lesions. In complex setting as unilateral cystectomy or pelvic adhesions, two-port access may be considered.

Laparoscopic Port Insertion Modifications According to the Surgeons Competency

“…Many previous studies presented same findings to our research. [16][17][18] In our research, we found that the Veres (closed) laparoscopic entrance method was preferred over the Hasson (open) laparoscopic approach. For the Veres needle, commonly utilised entrance assays are precise but not sensitive.…”

Paratubal Cystectomy in a Pregnant Woman Using the Single-Incision Laparoscopic Surgery (SILS) Technique

“…Several studies have demonstrated the feasibility and safety of SILS for adnexal lesions [ 36 , 37 ]. A recent retrospective study demonstrated longer operative times when SILS was applied to adnexal lesions [ 38 ], whilst shorter operating times have been described by other applications of the technique [ 39 ]. Nevertheless, the potential for improved cosmesis and perioperative outcome should not be discounted based on scarcity of evidence.…”

“…Rezai et al [ 47 ] noted the difficulty faced through not being able to alter the gravid uterus' impact upon the operating field [ 47 ]. Also, 24% of patients in a study by Huang et al [ 38 ] required the addition of an accessory port [ 38 ]. We were still able to excise the lesion using the SILS port in tandem with the accessory port, avoiding the placement of an additional trocar into the abdomen.…”

Effect of Two-Port Laparoscopic Surgery on Pregnancy Outcomes of Patients with Concurrent Adnexal Masses

“…Two-port laparoscopic surgery has been described in previous studies [ 5 , 6 , 7 ]. Under general anesthesia, a 2 cm skin incision was made at the umbilicus.…”