Single-Incision Laparoscopy as the Primary Approach to Benign Hysterectomies: A Single-Surgeon, Single-Year-Experience with a Retrospective Control

Abstract

Background: Most studies describing experience with laparoendoscopic single-site surgery hysterectomy are multi-institutional. These studies report the pooled experience of multiple providers. Consequently, these studies do not reflect the single-provider experience, a perspective that is most relevant to the individual practitioner. Objective: The aim of this study was to analyze the experience of a single provider with single-incision laparoscopy as a primary approach to all benign hysterectomies. Materials and Methods: This retrospective cohort study was conducted in a northeastern U.S. hospital involving patients who underwent hysterectomies for benign indications. The patients were operated on by a single surgeon over a 1-year period before and after initiation of a single-incision program at the hospital. Group differences were compared using the Student's t-test.The main outcome measure sought was operative time. Results: Overall 37 patients underwent hysterectomy via a single-incision approach, while 41 had conventional multiport laparoscopy. There were no statistically significant differences in body mass index, age, or number of previous surgeries between the groups. The weight of the uterine specimens was significantly higher in the single-incision group (249 -192), compared to the conventional laparoscopy group (106 -46). The mean time of procedure and EBL did not differ between the two groups. There was one conversion to laparotomy in the conventional laparoscopy group, as a result of extensive adhesions and technical difficulties, and one major intraoperative complication in the single-incision group (bladder and bowel injury) requiring minilaparotomy. Fourteen (39%) patients in the single-incision laparoscopy group required placement of at least one additional trocar through a separate incision. Conclusions: Transition to single-incision laparoscopy as the primary approach to hysterectomy for benign indications is possible. Operative time and morbidity are not significantly altered. ( J GYNECOL SURG 31:78)

Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta-analysis

“…Eleven studies compared LESS hysterectomy to conventional TLH [ 13 , 20 – 29 ], eleven studies compared LESS hysterectomy to LAVH [ 30 – 40 ], and in one study, both procedures were included [ 41 ]. Two studies also included supra-cervical hysterectomies [ 20 , 21 ]. The study by Koyanagi [ 42 ] was excluded as all data were already included in another study by the same author [ 40 ].…”

“…A total of 1985 women in the LESS group and 2466 women in the conventional hysterectomy were included in six randomized controlled trials [ 23 , 24 , 26 , 30 , 39 , 41 ], five prospective cohort studies [ 21 , 27 , 32 , 36 , 37 ], and 12 retrospective cohort studies [ 13 , 20 , 22 , 25 , 28 , 29 , 31 , 33 – 35 , 38 , 40 ]. Twenty of the studies (86.9%) were performed in Asia (fifteen in Korea [ 13 , 23 – 25 , 27 , 28 , 31 , 32 , 34 – 39 , 41 ], one in China [ 26 ], two in Japan [ 29 , 40 ], and two in Taiwan [ 30 , 33 ]), and the other three studies originated from the United States [ 20 ], Italy [ 22 ], and France [ 21 ]. Fourteen studies had a single center design [ 20 – 24 , 26 – 30 , 33 , 36 , 37 , 39 ], one RCT was multi-center, and in the other eight studies, the setting was unclear [ 13 , 25 , 31 , 32 , 34 , 35 , 38 , 40 ].…”

“…Twenty of the studies (86.9%) were performed in Asia (fifteen in Korea [ 13 , 23 – 25 , 27 , 28 , 31 , 32 , 34 – 39 , 41 ], one in China [ 26 ], two in Japan [ 29 , 40 ], and two in Taiwan [ 30 , 33 ]), and the other three studies originated from the United States [ 20 ], Italy [ 22 ], and France [ 21 ]. Fourteen studies had a single center design [ 20 – 24 , 26 – 30 , 33 , 36 , 37 , 39 ], one RCT was multi-center, and in the other eight studies, the setting was unclear [ 13 , 25 , 31 , 32 , 34 , 35 , 38 , 40 ].…”

“…Fifteen studies stated that there was no potential conflict of interest to disclose [ 13 , 20 – 27 , 30 – 33 , 35 , 38 ], five studies reported financial support (from a grant of Samsung Medical Center [ 39 ], from a grant of Korea Health Care technology [ 36 , 37 ], from Covidien [ 41 ], and from Kyung Hee University Research Fund [ 34 ]), and three studies remained unclear about their potential conflicts [ 28 , 29 , 40 ].…”

“…When evaluating the rate of additional ports needed during LESS surgery, 48 of the 1344 (3.5%) patients included had at least one additional port during LESS surgery versus one in the conventional group (0.06%) [ 38 ]. Fourteen of these cases can be attributed to Fridman et al where additional port was needed in 38% of the cases [ 20 ]. In the study by Jung et al one patient had an additional port due to an incidental finding of an appendiceal mucinous adenoma [ 34 ].…”