Low-cost total laparoscopic hysterectomy by single-incision laparoscopic surgery using only reusable standard laparoscopic instruments

Abstract

The purpose of this study was to demonstrate the feasibility and safety of total laparoscopic hysterectomy (TLH) by single-incision laparoscopic surgery (SILS) with conventional, reusable laparoscopic instruments, inserted through an inexpensive, self-constructed single-port device. Between June 2013 and April 2014, 15 TLHs by SILS were performed by a single surgeon (BJ). Only conventional, reusable laparoscopic instruments were used. The self-constructed single-port device was made by assembling a surgical glove, a wound protector, one reusable 10-mm trocar, and four reusable 5-mm trocars. The vaginal cuff was closed by intracorporeal suturing. Patient and perioperative data were analysed. Fifteen patients underwent TLH by SILS, and no conversion to standard laparoscopy or laparotomy was necessary. Mean operation time was 97 min (55–135 min), and mean drop in haemoglobin level was 1.2 g/dl (0–2.4 g/dl). There were no operative complications. Postoperative pain scores were low. The mean weight of the removed uterus was 118 g (50–208 g). TLH by SILS is feasible even when performed with reusable, conventional laparoscopic instruments. An inexpensive, self-constructed single-port device allows every surgeon worldwide to accomplish single-incision surgery without the need to invest in expensive ports, disposable instruments, sealing devices, or auto-locking sutures.