Transumbilical single-incision laparoscopic hysterectomy for large uterus: feasibility of the technique

Abstract

Total hysterectomy has been shown to have more clinical benefits when performed with a laparoscopic approach in comparison to traditional open surgery. However, multiple puncture sites might increase trocarassociated complications, such as bleeding, hernias, and wound infection and the cosmetic results are not always optimal. The umbilicus, an embryonic natural orifice, is an anatomical structure that may be used to perform advanced gynecological procedures, further reducing the morbidity associated with classical laparoscopic surgery. Leiomyomas are one of the most common indications for hysterectomy in women not wishing to conceive. Uterine size may be a limiting factor for laparoscopic single-incision approach to hysterectomy due to difficulties encountered to achieve a proper operative field. Several practical maneuvers can be used to assure a safe dissection while managing voluminous uteri. Herein we present our preliminary experience of transumbilical single-incision laparoscopic hysterectomy with a multichannel port in a patient affected of myomatous uterus.

Single-port access laparoscopic hysterectomy: A new dimension of minimally invasive surgery

“…[6–12] A small wound retractor (Alexis; Applied Medical, Rancho Santa Margarita, CA) is inserted into a wound opening transumbilically [Figure 1]. The wound retractor comprises a distal ring, a proximal ring, and a cylindrical connecting sleeve.…”

“…In the gynecological literature there are reported a number of studies using a wound retractor and a glove for single access in the umbilicus. [ 6 – 12 ] A small wound retractor (Alexis; Applied Medical, Rancho Santa Margarita, CA) is inserted into a wound opening transumbilically [ Figure 1 ]. The wound retractor comprises a distal ring, a proximal ring, and a cylindrical connecting sleeve.…”