Korean J Obstet Gynecol.  2012 Jan;55(1):22-28. 10.5468/KJOG.2012.55.1.22.

A comparison of single-port laparoscopically assisted vaginal hysterectomy using transumbilical SILS port access and three-port laparoscopically assisted vaginal hysterectomy

• Park SN
• Hong GY
• Kim HY
• Kim BR
• Lee C

• KMID: 1836759
• DOI: http://doi.org/10.5468/KJOG.2012.55.1.22

Abstract

OBJECTIVE
The purpose of this study was to compare surgical outcomes and patients' satisfaction between single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH) and conventional three-port access LAVH (TPA-LAVH) group.
METHODS
A prospective analysis was performed in patients who underwent laparoscopically assisted vaginal hysterectomy at a Wonkwang University Hospital between April 2010 and May 2011, a total of 138 women were enrolled in this study. One of these procedures was chosen by patient and was performed with their consent. Sixty-five women underwent SPA-LAVH using transumbilical SILS port access (SPA-LAVH group), and 73 women underwent conventional three-port LAVH (TPA-LAVH group).
RESULTS
There were no statistical differences between groups in the patients' demographic characteristics, mean operating time (93.4 +/- 20.2 minutes vs. 95.1 +/- 28.7 minutes, P = 0.696), postoperative changes in hemoglobin concentration (1.91 +/- 0.68 vs. 1.85 +/- 0.87 g/dL, P = 0.667), weight of the resected uterus (261.7 +/- 205.3 g vs. 311.8 +/- 268.3 g, P = 0.225), hospital stay (5.9 +/- 0.9 day vs. 6.4 +/- 1.6 day, P = 0.063), the rate of using an additional trocar (1.5% vs. 0%, P = 0.471), the rate of conversion to laparotomy (0% vs. 4.1%, P = 0.098) and postoperative pain scores (visual analogue scale) for 48 hours. However, patients' satisfaction after 6 weeks later was significantly greater in SPA-LAVH group than in conventional group, as evidenced by higher rate of fairly satisfactory (52.3% vs. 34.2%, P = 0.032) and very satisfactory (33.8% vs. 17.8%, P = 0.031).
CONCLUSION
SPA-LAVH using transumbilical SILS port access is comparable with TPA-LAVH in women undergoing LAVH. However, SPA-LAVH is better than TPA-LAVH in terms of satisfaction of patient.

Keyword

Single-port access; Three-port access; Laparoscopically assisted vaginal hysterectomy; Patients' satisfaction

MeSH Terms

Female
Hemoglobins
Humans
Hysterectomy, Vaginal
Laparotomy
Length of Stay
Pain, Postoperative
Prospective Studies
Surgical Instruments
Uterus
Hemoglobins

Figure

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  Fig. 1 (A) SILS port was placed in the umbilicus. (B) Photograph of umbilicus after skin suture.

Reference

1. Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy rates in the United States, 2003. Obstet Gynecol. 2007. 110:1091–1095.

2. Brummer TH, Seppala TT, Harkki PS. National learning curve for laparoscopic hysterectomy and trends in hysterectomy in Finland 2000-2005. Hum Reprod. 2008. 23:840–845.

3. Pelosi MA, Pelosi MA 3rd. Laparoscopic hysterectomy with bilateral salpingo-oophorectomy using a single umbilical puncture. N J Med. 1991. 88:721–726.

4. Merchant AM, Cook MW, White BC, Davis SS, Sweeney JF, Lin E. Transumbilical Gelport access technique for performing single incision laparoscopic surgery (SILS). J Gastrointest Surg. 2009. 13:159–162.

5. Kim TJ, Lee YY, Cha HH, Kim CJ, Choi CH, Lee JW, et al. Single-port-access laparoscopic-assisted vaginal hysterectomy versus conventional laparoscopic-assisted vaginal hysterectomy: a comparison of perioperative outcomes. Surg Endosc. 2010. 24:2248–2252.

6. Chen YJ, Wang PH, Ocampo JO, Twu NF, Yen MS, Chao KC. Single-port compared with conventional laparoscopic-assisted vaginal hysterectomy: a randomized controlled trial. Obstet Gynecol. 2011. 117:906–912.

7. Jung WJ, Lee M, Yim GW, Lee SH, Paek JH, Kwon HY, et al. A randomized prospective study of single-port and four-port approaches for hysterectomy in terms of postoperative pain. Surg Endosc. 2011. 25:2462–2469.

8. Lee JH, Choi JS, Jeon SW, Son CE, Hong JH, Bae JW. A prospective comparison of single-port laparoscopically assisted vaginal hysterectomy using transumbilical GelPort access and multiport laparoscopically assisted vaginal hysterectomy. Eur J Obstet Gynecol Reprod Biol. 2011. 158:294–297.

9. Revill SI, Robison JO, Rosen M, Hong MI. The reliability of a linear analogue for evaluating pain. Anaesthesia. 1976. 31:1191–1198.

10. Voermans RP, Van Berge Henegouwen MI, Fockens P. Natural orifice transluminal endoscopic surgery (NOTES). Endoscopy. 2007. 39:1013–1017.

11. Pelosi MA, Pelosi MA 3rd. Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy). J Reprod Med. 1992. 37:588–594.

12. Pelosi MA, Pelosi MA 3rd. Laparoscopic supracervical hysterectomy using a single-umbilical puncture (mini-laparoscopy). J Reprod Med. 1992. 37:777–784.

13. Park HS, Kim TJ, Song T, Kim MK, Lee YY, Choi CH, et al. Single-port access (SPA) laparoscopic surgery in gynecology: a surgeon's experience with an initial 200 cases. Eur J Obstet Gynecol Reprod Biol. 2011. 154:81–84.

14. Kaouk JH, Haber GP, Goel RK, Desai MM, Aron M, Rackley RR, et al. Single-port laparoscopic surgery in urology: initial experience. Urology. 2008. 71:3–6.

15. Desai MM, Stein R, Rao P, Canes D, Aron M, Rao PP, et al. Embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) for advanced reconstruction: initial experience. Urology. 2009. 73:182–187.

16. Park BJ, Kim YW, Ro DY, Kim TE, Ryu KS, Kim JH. Evaluation of 110 cases of single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH) and comparison with multi-port access. Korean J Obstet Gynecol. 2010. 53:633–639.

17. Ghezzi F, Cromi A, Colombo G, Uccella S, Bergamini V, Serati M, et al. Minimizing ancillary ports size in gynecologic laparoscopy: a randomized trial. J Minim Invasive Gynecol. 2005. 12:480–485.

18. Cao LP, Que RS, Zhou F, Ding GP, Jing DX. Transumbilical single-port laparoscopic cholecystectomy using traditional laparoscopic instruments: a report of thirty-six cases. J Zhejiang Univ Sci B. 2011. 12:862–866.

19. Aprea G, Coppola Bottazzi E, Guida F, Masone S, Persico G. Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. J Surg Res. 2011. 166:e109–e112.

20. Ma J, Cassera MA, Spaun GO, Hammill CW, Hansen PD, Aliabadi-Wahle S. Randomized controlled trial comparing single-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg. 2011. 254:22–27.