Abstract
Laparoendoscopic single site surgery (LESS) refers to a spectrum of surgical techniques that allow the performance of laparoscopic surgery through consolidation of all ports into one surgical incision. LESS has emerged as a potentially less invasive alternative to multiport laparoscopy and in the last year in gynecology; hence, this approach has been largely applied for selective indications to perform total hysterectomy. We performed a literature review on single site hysterectomy and described indications and technique, highlighting practical problems, pointers, limitations and recent technical development as robotic assistance.
Highlights
Hysterectomy is the most common major gynecologic surgery performed worldwide.Hysterectomy can be performed abdominally, vaginally or laparoscopically
Laparoendoscopic single site surgery (LESS) is a novel surgical approach that has been associated with reduced postoperative pain, improved cosmetic outcome, avoidance of ancillary port complications and faster recovery compared to multiport laparoscopy [1]
Hysterectomy may require a higher level of surgical skill that adnexal surgery does; LESS is widely applied for laparoscopic-assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) [5,6,7]
Summary
Hysterectomy is the most common major gynecologic surgery performed worldwide. Hysterectomy can be performed abdominally, vaginally or laparoscopically. Laparoscopic approaches include total laparoscopic hysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy, and robotic-assisted laparoscopic hysterectomy. Invasive surgery should be used whenever feasible, due to the well-known advantages of excellent cosmesis, shorter hospital stay, faster recovery and return to routine activities, decreased blood loss, decline in wound related complications such as infection, hematoma and dehiscence, and other major postoperative complications such as deep vein thrombosis and respiratory morbidities. In the last few decades, there has been an increasing interest in even less invasive surgery such as mini-laparoscopy, LESS, and natural orifice endoscopic surgery (NOTES), and the development of new specific instruments has led to a gradual application of these new approaches in routine practice. LESS surgery is an attempt at improving cosmetic outcome, faster recovery and decrease postoperative pain and hospital stay.
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