Accessibility and surgical outcomes of transumbilical single-port laparoscopy using straight instruments for hysterectomy in difficult conditions

Abstract

ObjectivesTo evaluate the accessibility of transumbilical single-port laparoscopy for hysterectomy in difficult conditions. Materials and methodsThis prospective observational study recruited patients with benign diseases who were scheduled for laparoscopic hysterectomy between March 2010 and October 2011 to undergo the transumbilical single-port approach with straight instruments and a laparoscope. ResultsIn total, 109 patients were included with a mean [± standard error of the mean (SEM)] age of 45.9 ± 0.4 years and mean body mass index of 23.9 ± 0.3 kg/m2. The yielded mean uterine weight was 403.4 ± 25.3 g, with 28 (25.7%) weighing ≥500 g, including four specimens >1000 g, and 44 (40.4%) needed concurrent adhesiolysis. The operative time was 117.2 ± 4.2 minutes, estimated blood loss was 270.3 ± 22.9 mL, and the postoperative hospital stay was 2.8 ± 0.1 days. Patients with a uterus weighing ≥500 g had a higher intraoperative blood loss in comparison with those with a uterus weighing <500 g (375.4 ± 55.3 mL vs. 234.0 ± 23.0 mL; p < 0.05) and a higher incidence of blood transfusion (17.9% and 6.2%, respectively). The single-port approach was abandoned in four (3.7%) patients with severe pelvic adhesion—an additional port was opened for extensive adhesiolysis. None of the patients with a voluminous uterus needed an additional port. There were no major intraoperative or postoperative complications. ConclusionThe single-port approach using straight, conventional laparoscopic instruments was feasible and safe in the majority of the patients undergoing hysterectomy, and was found to be accessible even in cases with a large uterus. The patients benefitted from this approach and had less abdominal wounds. However, patients with a voluminous uterus tended to have more intraoperative blood loss, and in some cases with severe adhesions, additional port(s) were required for surgical effectiveness.