An innovative technology of transumbiliсal laparoscopy in gynecology

Abstract

Aim. To analyze the advantages and weaknesses of single-port transumbiliсal laparoscopy in treatment of disorders of female genital tract. Methods. Transumbiliсal laparoscopy was performed using the first Russian toolkit for single-port laparoscopy surgery. 70 female patients with different disorders of female genital tract (ectopic pregnancy - 41, benign ovarian tumors - 8, ovarian apoplexy - 16, leiomyoma of uterus - 5) who needed a surgery were randomized to 2 groups 35 patients each. Patients from the first group underwent single-port transumbiliсal laparoscopy surgery through a single puncture of the abdominal wall, patients from the second group underwent a surgery with ports introduced into the abdomen by several trocars. Results. In patients treated by conventional laparoscopy the surgery duration was 29.2±2.3 minutes, compared to 46.1±3.3 minutes in patients treated with single-port transumbiliсal laparoscopy. However, the duration of single-port transumbiliсal laparoscopy has decreased significantly after the first 6 surgeries were performed, and if these surgeries were excluded from the analysis, the average single-port transumbiliсal laparoscopy duration was 35.3±0.6 minutes. Postoperative pain level assessed by visual analogue scale was somewhat lower in patients after single-port transumbiliсal laparoscopy, though, the difference was not significant. An assessment of the abdominal wall and suture visual assessment were performed. Transumbiliсal suture was completely concealed in the umbilicus, thus, single-port transumbiliсal laparoscopy provides a good cosmetic effect. There were some technical difficulties associated with the single-port introduction of all medical instruments, which were overcome by medical instruments length and curvature modification and revised position of surgeons in the operating theatre. Conclusion. The advantages of the new technology were reduction of abdominal wall trauma, reduction of complications associated with the introduction of the trocar, a slight reduction of postoperative pain, good cosmetic results after surgery. Further research is needed to determine the differential approach to the choice of operation technique.