Obstet Gynecol Sci.  2014 Sep;57(5):386-392. 10.5468/ogs.2014.57.5.386.

A comparison of clinical and surgical outcomes between laparo-endoscopic single-site surgery and traditional multiport laparoscopic surgery for adnexal tumors

• Lee IO
• Yoon JW
• Chung D
• Yim GW
• Nam EJ
• Kim S
• Kim SW
• Kim YT

• KMID: 2051720
• DOI: http://doi.org/10.5468/ogs.2014.57.5.386

Abstract

OBJECTIVE
The purpose of this study was to compare clinical and surgical outcomes between laparo-endoscopic single-site (LESS) surgery and traditional multiport laparoscopic (TML) surgery for treatment of adnexal tumors.
METHODS
Medical records were reviewed for patients undergoing surgery for benign adnexal tumors between January 2008 and April 2012 at our institution. All procedures were performed by the same surgeon. Clinical and surgical outcomes for patients undergoing LESS surgery using Glove port were compared with those patients undergoing TML surgery.
RESULTS
A review of 129 patient cases undergoing LESS surgery using Glove port and 100 patient cases undergoing TML surgery revealed no significant differences in the baseline characteristics of the two groups. The median operative time was shorter in the LESS group using Glove port at 44 minutes (range, 19-126 minutes) than the TML group at 49 minutes (range, 20-196 minutes) (P=0.0007). There were no significant differences between in the duration of postoperative hospital stay, change in hemoglobin levels, pain score or the rate of complications between the LESS and TML groups.
CONCLUSION
LESS surgery showed comparable clinical and surgical outcomes to TML surgery, and required less operative time. Future prospective trials are warranted to further define the benefits of LESS surgery for adnexal tumor treatment.

Keyword

Adnexal tumor; Glove port; Laparo-endoscopic single-site surgery; Laparoscopy; Port system

MeSH Terms

Humans
Laparoscopy*
Length of Stay
Medical Records
Operative Time

Figure

• 

  Fig. 1 (A) A 4-channel model of Glove port. (B,C) Glove port demonstrated in the operation.

Reference

1. Bradford LS, Boruta DM. Laparoendoscopic single-site surgery in gynecology: a review of the literature, tools, and techniques. Obstet Gynecol Surv. 2013; 68:295–304.

2. Shapiro HI, Adler DH. Excision of an ectopic pregnancy through the laparoscope. Am J Obstet Gynecol. 1973; 117:290–291.

3. Medeiros LR, Rosa DD, Bozzetti MC, Fachel JM, Furness S, Garry R, et al. Laparoscopy versus laparotomy for benign ovarian tumour. Cochrane Database Syst Rev. 2009; (2):CD004751.

4. Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009; (3):CD003677.

5. Escobar PF, Starks D, Fader AN, Catenacci M, Falcone T. Laparoendoscopic single-site and natural orifice surgery in gynecology. Fertil Steril. 2010; 94:2497–2502.

6. Lee YY, Kim TJ, Kim CJ, Park HS, Choi CH, Lee JW, et al. Single port access laparoscopic adnexal surgery versus conventional laparoscopic adnexal surgery: a comparison of peri-operative outcomes. Eur J Obstet Gynecol Reprod Biol. 2010; 151:181–184.

7. 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.

8. Yim GW, Jung YW, Paek J, Lee SH, Kwon HY, Nam EJ, et al. Transumbilical single-port access versus conventional total laparoscopic hysterectomy: surgical outcomes. Am J Obstet Gynecol. 2010; 203:26.e1–26.e6.

9. Fagotti A, Rossitto C, Marocco F, Gallotta V, Bottoni C, Scambia G, et al. Perioperative outcomes of laparoendoscopic single-site surgery (LESS) versus conventional laparoscopy for adnexal disease: a case-control study. Surg Innov. 2011; 18:29–33.

10. Yoon BS, Park H, Seong SJ, Park CT, Jun HS, Kim IH. Single-port versus conventional laparoscopic salpingectomy in tubal pregnancy: a comparison of surgical outcomes. Eur J Obstet Gynecol Reprod Biol. 2011; 159:190–193.

11. Escobar PF, Frumovitz M, Soliman PT, Frasure HE, Fader AN, Schmeler KM, et al. Comparison of single-port laparoscopy, standard laparoscopy, and robotic surgery in patients with endometrial cancer. Ann Surg Oncol. 2012; 19:1583–1588.

12. Chen YJ, Wang PH, Ocampo EJ, 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.

13. Fader AN, Escobar PF. Laparoendoscopic single-site surgery (LESS) in gynecologic oncology: technique and initial report. Gynecol Oncol. 2009; 114:157–161.

14. Podolsky ER, Rottman SJ, Poblete H, King SA, Curcillo PG. Single port access (SPA) cholecystectomy: a completely transumbilical approach. J Laparoendosc Adv Surg Tech A. 2009; 19:219–222.

15. Canes D, Desai MM, Aron M, Haber GP, Goel RK, Stein RJ, et al. Transumbilical single-port surgery: evolution and current status. Eur Urol. 2008; 54:1020–1029.

16. Fagotti A, Bottoni C, Vizzielli G, Alletti SG, Scambia G, Marana E, et al. Postoperative pain after conventional laparoscopy and laparoendoscopic single site surgery (LESS) for benign adnexal disease: a randomized trial. Fertil Steril. 2011; 96:255–259.e2.

17. Hernandez E, Miyazawa K. The pelvic mass. Patients' ages and pathologic findings. J Reprod Med. 1988; 33:361–364.

18. Cannistra SA. Cancer of the ovary. N Engl J Med. 2004; 351:2519–2529.

19. Hillard PJ. Benign diseases of the female reproductive tract. In : Berek JS, editor. Berek & Novak's gynecology. 15th ed. Philadelphia: Lippincott Williams & Wilkins;2011. p. 410–412.

20. Kadar N, Reich H, Liu CY, Manko GF, Gimpelson R. Incisional hernias after major laparoscopic gynecologic procedures. Am J Obstet Gynecol. 1993; 168:1493–1495.

21. Podolsky ER, Curcillo PG 2nd. Single port access (SPA) surgery: a 24-month experience. J Gastrointest Surg. 2010; 14:759–767.

22. Worley MJ, Slomovitz BM, Ramirez PT. Complications of laparoscopy in benign and oncologic gynecological surgery. Rev Obstet Gynecol. 2009; 2:169–175.

23. Escobar PF, Starks DC, Fader AN, Barber M, Rojas-Espalliat L. Single-port risk-reducing salpingo-oophorectomy with and without hysterectomy: surgical outcomes and learning curve analysis. Gynecol Oncol. 2010; 119:43–47.