Obstet Gynecol Sci.  2015 May;58(3):239-245. 10.5468/ogs.2015.58.3.239.

Single-port access versus conventional multi-port access total laparoscopic hysterectomy for very large uterus

• Lee J
• Kim S
• Nam EJ
• Hwang SM
• Kim YT
• Kim SW

• KMID: 2148937
• DOI: http://doi.org/10.5468/ogs.2015.58.3.239

Abstract

OBJECTIVE
The aim of this study was to compare the surgical outcomes of single-port access (SPA) and conventional multi-port access total laparoscopic hysterectomies (TLH) among patients with very large uteri (500 g or more).
METHODS
Fifty consecutive patients who received TLH for large uterine myomas and/or adenomyoses weighing 500 g or more between February 2009 and December 2012 were retrospectively reviewed. SPA and conventional TLH were each performed in 25 patients. Surgical outcomes, including operation time, estimated blood loss, postoperative hemoglobin change, postoperative hospital stay, postoperative pain, and perioperative complications, were compared between the two groups.
RESULTS
There were no significant demographic differences between the two groups. All operations were completed laparoscopically with no conversion to laparotomy. Total operation time, uterus weight, estimated blood loss, and postoperative hemoglobin change did not significantly differ between the two groups. Postoperative hospital stay was significantly shorter for the SPA-TLH group compared to that of the conventional TLH group (median [range], 3 [2.0-6.0] vs. 4 [3-7] days; P=0.004]. There were no inter-group differences in postoperative pain at 6, 24, and 72 hours after surgery. There was only one complicated case in each group.
CONCLUSION
SPA-TLH in patients with large uteri weighing 500 g or more is as feasible as conventional TLH. SPA-TLH is associated with shorter hospital stays compared to that of conventional TLH.

Keyword

Hysterectomy; Laparoscopy; Neoplasms; Uterus

MeSH Terms

Adenomyosis
Humans
Hysterectomy*
Laparoscopy
Laparotomy
Leiomyoma
Length of Stay
Pain, Postoperative
Postoperative Hemorrhage
Retrospective Studies
Uterus*

Figure

• 

  Fig. 1 Intraoperative findings in single-port access total laparoscopic hysterectomy. (A) Left utero-ovarian ligaments were ligated with the LigaSure system, as the uterus was pushed medially with a biopsy forceps containing a slightly bent steel shaft (arrow). (B) The uterus was medially pushed away with a biopsy forceps (arrow) to create a right pelvic space to dissect the right uterine artery (arrowhead). (C) The left uterine artery (arrowhead) was ligated with the LigaSure system. (D) The posterior vaginal wall was cut with a monopolar L-hook (M), as the uterus was lifted up with a biopsy forceps. M, monopolar; Ut, uterus.

Reference

1. Kongwattanakul K, Khampitak K. Comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy: a randomized controlled trial. J Minim Invasive Gynecol. 2012; 19:89–94.

2. Bijen CB, Vermeulen KM, Mourits MJ, Arts HJ, Ter Brugge HG, van der Sijde R, et al. Cost effectiveness of laparoscopy versus laparotomy in early stage endometrial cancer: a randomized trial. Gynecol Oncol. 2011; 121:76–82.

3. 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.

4. 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.

5. Choi YS, Park JN, Oh YS, Sin KS, Choi J, Eun DS. Single-port vs. conventional multi-port access laparoscopy-assisted vaginal hysterectomy: comparison of surgical outcomes and complications. Eur J Obstet Gynecol Reprod Biol. 2013; 169:366–369.

6. Wheeless CR Jr. A rapid inexpensive, and effective method of surgical sterilization by laparoscopy. J Reprod Med. 1969; 3:65–69.

7. Thompson B, Wheeless RC. Outpatient sterilization by laparoscopy: a report of 666 patients. Obstet Gynecol. 1971; 38:912–915.

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

9. Song T, Kim TJ, Kim MK, Park H, Kim JS, Lee YY, et al. Single port access laparoscopic-assisted vaginal hysterectomy for large uterus weighing exceeding 500 grams: technique and initial report. J Minim Invasive Gynecol. 2010; 17:456–460.

10. Park SN, Hong GY, Kim HY, Kim BR, Lee C. A comparison of single-port laparoscopically assisted vaginal hysterectomy using transumbilical SILS port access and three-port laparoscopically assisted vaginal hysterectomy. Korean J Obstet Gynecol. 2012; 55:22–28.

11. Lee GW, Kim JK, Shin CS, Choi WK, Kang BH, Yang JB, et al. Single port access laparoscopic hysterectomy for large uterus of more than 500 g. Korean J Obstet Gynecol. 2012; 55:392–397.

12. Song T, Lee Y, Kim ML, Yoon BS, Joo WD, Seong SJ, et al. Single-port access total laparoscopic hysterectomy for large uterus. Gynecol Obstet Invest. 2013; 75:16–20.

13. 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.

14. Ribeiro SC, Ribeiro RM, Santos NC, Pinotti JA. A randomized study of total abdominal, vaginal and laparoscopic hysterectomy. Int J Gynaecol Obstet. 2003; 83:37–43.

15. Tai HC, Lin CD, Wu CC, Tsai YC, Yang SS. Homemade transumbilical port: an alternative access for laparoendoscopic single-site surgery (LESS). Surg Endosc. 2010; 24:705–708.

16. Jung YW, 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.

17. 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.

18. Choi YS, Shin KS, Choi J, Park JN, Oh YS, Rhee TE. Single-port access laparoscopy-assisted vaginal hysterectomy: our initial experiences with 100 cases. Minim Invasive Surg. 2012; 2012:543627.

19. 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.

20. Yoon A, Kim TJ, Lee WS, Kim BG, Bae DS. Single-port access laparoscopic staging operation for a borderline ovarian tumor. J Gynecol Oncol. 2011; 22:127–130.