Korean J Obstet Gynecol.  2010 Jul;53(7):633-639. 10.5468/kjog.2010.53.7.633.

Evaluation of 110 cases of single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH) and comparison with multi-port access

• Park BJ
• Kim YW
• Ro DY
• Kim TE
• Ryu KS
• Kim JH

• KMID: 2273944
• DOI: http://doi.org/10.5468/kjog.2010.53.7.633

Abstract

OBJECTIVE
To evaluate the safety and feasibility of single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH) using conventional laparoscopic instruments compared to multi-port access laparoscopically assisted vaginal hysterectomy (MPA-LAVH).
METHODS
We reviewed the medical records of 220 patients with uterine leiomyoma or adenomyosis who underwent 110 SPA-LAVH and 110 MPA-LAVH in Incheon St. Mary's Hospital between April 2007 and November 2009. We performed SPA-LAVH with conventional rigid straight laparoscopic instruments in all cases. We also performed a new vaginal cuff closure method, Kim's Vaginal Vault Suspension Method, named after the operator (Kim, YW) in both SPA-LAVH and MPA-LAVH.
RESULTS
There was no significant difference in patients' age, operating time, uterine weight, hemoglobin change, frequency of blood transfusion, and incidence of postoperative fever between the two groups. The patients' mean age was 46.1+/-7.0 years (SPA-LAVH) and 45.5+/-6.3 years (MPA-LAVH). The mean operating time was 87.2+/-21.0 minutes (SPA-LAVH) and 83.3+/-20.3 minutes (MPA-LAVH). The mean uterine weight was 261.4+/-139.7 g (SPA-LAVH) and 257.8+/-132.9 g (MPA-LAVH). The mean hemoglobin change was 1.1+/-0.7 g/dL (SPA-LAVH) and 1.2+/-0.6 g/dL (MPA-LAVH). Neither bowel injury nor urinary tract injury occurred during the operation in the two groups. One of the SPA-LAVH and one of the MPA-LAVH cases were converted to abdominal total hysterectomy. The mean hospital stay time was shorter with SPA-LAVH (2.6+/-0.6 days [SPA-LAVH] and 3.3+/-0.7 days [MPA-LAVH], P<0.05).
CONCLUSION
SPA-LAVH using conventional rigid straight laparoscopic instruments can be offered as a safe and feasible alternative to MPA-LAVH.

Keyword

Single-port access; Multi-port access; Laparoscopically assisted vaginal hysterectomy; Conventional laparoscopic instruments

MeSH Terms

Adenomyosis
Blood Transfusion
Female
Fever
Hemoglobins
Humans
Hysterectomy
Hysterectomy, Vaginal
Incidence
Leiomyoma
Length of Stay
Medical Records
Urinary Tract
Hemoglobins

Figure

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  Fig. 1 (A) Performing a 1.5 to 2.0 cm intra-umbilical vertical skin incision. (B) Using conventional rigid straight laparoscopic instruments in handmade single-port system.

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  Fig. 2 (A) Laparoscopic view of single-port procedure. (B) Subcuticular suture of umbilical skin.

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