Two-phase laparoendoscopic single-site cervical ligament-sparing hysterectomy: An initial experience

Abstract

Objective:To report our initial experience with and the short-term outcomes of two-phase laparoendoscopic single-site cervical ligament-sparing hysterectomy (LESS-CLSH).Materials and Methods:A retrospective case study included 40 women who underwent LESS-CLSH from January 2014 to December 2016 at Buddhist Tzu Chi General Hospital. Uterine specimens were extracted through contained manual morcellation with a tissue pouch. The first phase was LESS supracervical hysterectomy and conization of the internal orifice of the cervix. The second phase was transvaginal cervical conization and cylinderization. Women with a uterus diameter of >12 cm, a broad ligament myoma, or severe pelvic adhesion were categorized into a difficult group, and others were categorized into a nondifficult group.Results:The difficult group required more time and had more blood loss than the nondifficult group. The mean surgical time was 187.2 ± 33.9 and 139.1 ± 20.7 min, and the mean blood loss was 533.3 ± 333.3 and 225.3 ± 168.2 mL in the difficult and nondifficult groups, respectively. The overall visual analog scale (VAS) pain scores at 0–4, 24, and 48 h after surgery were 7.1 ± 1.9, 4.2 ± 1.6, and 2.3 ± 1.5, respectively; no difference in the VAS pain scores, pain relief score, and hospitalization duration was observed between the two groups. Minor surgical complications or adverse events on follow-up were noted. Three months after surgery, the diameter and thickness of the cervix were decreased by approximately 0.5 and 1.0 cm, respectively.Conclusion:LESS-CLSH is a minimally invasive, safe, and feasible approach, even for difficult laparoscopic hysterectomy. Contained manual morcellation enables more controlled specimen removal than morcellation only.

Safety and efficacy of contained manual morcellation during laparoscopic or robotic gynecological surgery

“…A total of 165 women were included, comprising 149 who underwent laparoscopic surgeries and 16 who underwent robotic surgeries from February 2014 to April 2017 at the Hualien Tzu Chi Medical Center. The inclusion criteria were women at any age undergoing surgeries such as robotic or laparoendoscopic single‐site (LESS) surgery with or without additional supracervical hysterectomy (SCH) with a 5‐mm port approach, cervical ligament‐sparing hysterectomy (SCH plus internal and external conization), myomectomy, and ovarian/adnexal tumor resection (e.g. large teratoma and ovarian tumor with irreversible torsion or unknown characteristic/suspect of early‐stage malignancy) (Table ).…”

“…CMM was first used in a case of difficult laparoscopic subtotal hysterectomy in 2014. 12 After gaining initial experience, 13 the use of CMM was extended to other singlesite laparoscopic or robotic gynecological surgeries. 14 The aim of the present study was to demonstrate the safety and efficacy of CMM in minimally invasive surgeries and to share related experiences.…”