Feasibility Of Laparoendoscopic Single-site Surgery Research Articles

Evaluation of laparo-endoscopic single-site surgery for adnexal mass in pregnant women

BackgroundSurgery for adnexal mass does occur in pregnant women and therefore the choice of surgery during pregnancy needs to be carefully considered and studied. This study aimed to evaluate the safety and feasibility of Laparo-endoscopic Single-site Surgery (LESS) for adnexal mass during pregnancy and investigate the perioperative condition, pregnancy complications, and obstetric outcomes of operative women during pregnancy.MethodsThis study retrospectively collected medical records and surgery videos of 20 pregnant women who underwent LESS for adnexal mass between November 2019 and January 2022. Baseline characteristics, operative-related variables, and pregnancy outcomes were followed up.ResultsLESS for adnexal mass was successfully performed in 20 pregnant women, with very satisfactory surgery outcomes reported in all cases. The average gestational age at operation was 15+2 weeks (range, 5+1- 25+4 weeks). The median operative time was 80.8 min (range, 40 -185 min) and the average operative bleeding was 28.0 ml (range, 10–50 ml). The average VAS of 24 h postoperatively was 1 (range, 0–2), and the average length of hospital stay was 5.15 days (range, 3–7 days). All these women delivered a healthy newborn at full term except 1 woman induced abortion for her own reasons at 16+5 weeks gestational age (GA). The average GA of delivery was 39+1 weeks (range, 37–40+1 weeks), the average birth weight was 3228.95 g (range, 2740–3930 g), and the average Apgar score at 5 min was 9.95 (range, 9–10).ConclusionsLESS for adnexal mass is safe and feasible for pregnant women.

Laparoendoscopic single-site compared with conventional laparoscopic surgery for gynaecological acute abdomen in pregnant women.

ObjectiveTo estimate the safety and feasibility of laparoendoscopic single-site surgery (LESS) in pregnant patients with acute abdomen.MethodsBaseline characteristics, surgical results, and obstetric and neonatal outcomes were retrospectively compared between single and multiport procedures in patients who underwent laparoscopic surgery during pregnancy between 2017 and 2021.ResultsFifty-four pregnant patients were included: 26 who underwent LESS (salpingectomy, 11 cases/cystectomy, 15 cases) and 28 who underwent conventional laparoscopic surgeries (salpingectomy, 12 cases/cystectomy, 16 cases) during pregnancy. One patient in the single-port group required additional ports. No patients converted to laparotomy. In patients undergoing salpingectomy, the single-port group showed lower 8- and 24-h postoperative pain scores, shorter hospital stays, and lower Self-rating Anxiety Scale scores prior to discharge versus conventional laparoscopy. One patient experienced postoperative vaginal bleeding and a missed abortion during follow-up. In patients receiving cystectomy, 8- and 24-h pain scores, postoperative hospital stay, and anxiety scores were lower in the single-port versus multiport group. Other outcomes were comparable between the groups.ConclusionThe feasibility and efficacy of laparoscopic surgery during pregnancy is similar between single- or multiport routes, however, the single-port route may be associated with less postoperative pain, shorter hospital stay, and lower anxiety.

Clinical Comparison of Laparoendoscopic Single-site Surgery and Multiport Laparoscopic Surgery for the Removal of Ovarian Endometrioid Cyst

Background: Endometriosis is a common, chronic gynecological disease. Laparoscopy is currently the preferred method of ovarian endometriosis. However, the safety and feasibility of laparoendoscopic single-site surgery for ovarian endometrioid cyst removal still need to be discussed. Objective: To explore the safety and feasibility of laparoendoscopic single-site (LESS) surgery versus conventional multiport laparoscopic (CMPL) surgery for the ovarian endometrioid cystectomy. Methods: We retrospectively analyzed the data of 47 patients who had undergone LESS and LESS ovarian cystectomy due to ovarian endometrioid cyst in our hospital from March 2018 to April 2019. The patients were classified into single-port group (14) and multiport group (33) based on surgical paths. The patients’ general characteristics and perioperative outcomes compared. Results: There were no significant statistical differences between the two groups (P>0.05) in the operation time and the maximum body temperature in 24 h after operation. There were significant statistical differences (all P<0.05) in postoperative decrease of Hb, intraoperative bleeding volume, total hospital stay and CS score. Conclusion: LESS for ovarian endometrioid cyst removal is safe and feasible, and it better than CMPL in relieving postoperative pain and inproving cosmetic effects and so on.

Pregnancy-preserving Laparoendoscopic Single-site Surgery for Gynecologic Disease: A Case Series

The study objective was to assess the feasibility of laparoendoscopic single-site surgery (LESS) for the management of nonobstetric, gynecologic disease processes in pregnant patients. A retrospective case series of 13 pregnant women aged 21 to 42 years who underwent LESS for various gynecologic pathology. If able to be contacted, the patients were followed up until the delivery of the fetus. The surgeries were performed in a single institution between January 2015 and June 2019. The patients were selected if a laparoscopic intervention was indicated. The cases included 6 ovarian cystectomies and 2 salpingo-oophorectomies for adnexal masses; 1 myomectomy for a degenerated myoma; 1 salpingectomy for a heterotopic pregnancy; 2 cerclage placements for recurrent pregnancy loss and cervical insufficiency; and 1 paratubal cystectomy. The patients underwent LESS through a 2.5-cm umbilical incision. The masses were exteriorized using a laparoscopic specimen retrieval bag, with the exception of 2 large adnexal masses, which were aspirated at the incision site, exteriorized after content drainage, and cystectomies performed extracorporeally. The fascial incision wasrepaired with a permanent suture. Various data were collected from patients, including age, surgical and obstetric history, gestational age at surgery, and ultrasonic imaging results. The outcomes measured were operative duration, intraoperative bleeding, postoperative symptoms, fetal monitoring before andafter surgery, pathologic findings, conversions, intraoperative complications, and pregnancy outcomes. Eight cases were performed in the first trimester, 4 in the second trimester, and 1 in the third trimester, with the surgeries lasting between 45 minutes and 298 minutes. The blood loss ranged from 5 mL to 300 mL, and postoperative symptoms of mild pelvic or abdominal pain were reported. There were 2 conversions to traditional multiport laparoscopic surgery for the 2 cerclage cases, and there were no open surgery conversions or intraoperative complications. The fetal heart rate ranged between 130 beats per minute and 167 beats per minute postoperatively. Of the 9 patients who were able to be contacted for follow-up, all had successful deliveries. One patient was healthy at 31 weeks and 5 days without complication at the time of her last follow-up. LESS may be performed by experienced surgeons on gravid patients in any trimester for adnexal masses, myomas, heterotopic pregnancy, and cervical incompetence. Future multiple-center studies may provide further evidence that LESS is a feasible and safe option for gynecologic surgery during pregnancy.

Laparo-endoscopic single site surgery in pediatrics: Feasibility and surgical outcomes from a preliminary prospective Canadian experience.

Laparo-endoscopic single-site surgery (LESS) is becoming an alternative to standard laparoscopic surgery. Proposed advantages include enhanced cosmesis and faster recovery. We assessed the early post-operative surgical outcomes of LESS surgery utilizing different instruments in the pediatric urological population in Canada. We prospectively captured data on all patients undergoing LESS at our institution between February 2011 and August 2012. This included patient age, operative time, length of stay, complications and short-term surgical outcomes. Different instruments/devices were used to perform the procedures. Access was achieved through a transumbilical incision. A total of 16 LESS procedures were performed, including seven pyeloplasties, four unilateral and one bilateral varicocelectomies, two simple nephrectomies, one renal cyst decortication and one pyelolithotomy. There was no statistical difference in the operative times, hospital length of stay and cost (pyeloplasty only) in patients undergoing pyeloplasty and varicocelectomy using the LESS technique when compared to an age matched cohort of patients managed with the traditional laparoscopic approach. One pyeloplasty in the LESS group required conversion to open due to a small intra-renal pelvis. There were no immediate or short term post-operative complications; however, one patient experienced a decrease in renal function status post LESS pyeloplasty. Since all procedures were performed by a vastly experienced surgeon at a tertiary center, the generalizability of the results cannot be assessed. There are only a few series that have assessed the role of LESS in pediatric urological surgery. Although our experience is limited by a heterogeneous group of patients with a short follow-up period, the present cohort demonstrates the safety and feasibility of LESS. Further evaluation with randomized studies is required to better assess the role of LESS in pediatric urology.

Feasibility of laparoendoscopic single-site surgery in supracervical hysterectomy: technique and retrospective case-control comparison

One recent innovation in the field of gynecology is laparoendoscopic single-site surgery (LESS). It is associated with reduced postoperative pain and better cosmetic outcome. The present paper aims to explain techniques and instrumentations associated with single-port hysterectomies. A retrospective case-control study is included, comparing LESS with conventional four-port hysterectomies to highlight the feasibility of LESS. This study involved literature search and personal experience regarding single-port hysterectomy and a retrospective case-control study of 34 patients who underwent supracervical hysterectomy between April 2011 and November 2012. Operating time, blood loss, and length of hospital stay were similar in the two groups. Patient’s evaluation of the cosmetic result was in favor of LESS, however not significant. LESS represents a new frontier in minimally invasive surgery. New instrumentation and recommendations have been developed which are expected to make the technique more feasible. This study demonstrates that LESS supracervical hysterectomy has comparable operative outcomes to conventional laparoscopic hysterectomy and is a feasible approach for supracervical hysterectomy. Based on the literature and our experience, a feasible step by step technique for surgeons who are interested in performing supracervical LESS hysterectomy is described. Comparative data and prospective trials are required in order to determine the clinical utility and impact of LESS in treatment of gynecological conditions in the future.

Laparoendoscopic single-site versus conventional laparoscopic radical nephrectomy for renal cell cancer in patients with increased comorbidities and previous abdominal surgery: preliminary results of a single-centre retrospective study

Laparoendoscopic single-site surgery (LESS) represents an evolution of laparoscopy for the treatment for urologic diseases. The aim of this study is to investigate the feasibility of LESS in patients with increased comorbidities and previous abdominal surgery undergoing radical nephrectomy (LESS-RN) for renal cell carcinoma. A total of 25 patients with increased comorbidities and previous abdominal surgery who underwent LESS-RN were compared to 31 patients with the same characteristics after conventional laparoscopic radical nephrectomy (LRN). LRN was performed between January 2009 and May 2010, and LESS-RNs were performed between June 2010 and November 2011. Demographic data and perioperative and postoperative variables were recorded and analysed. The mean ASA score in the LESS-RN and LRN groups was 3.2±0.4, and the mean BMI was 32.7±2.1 and 34.2±0.8kg/m(2), respectively. The mean operative time in the LESS-RN and LRN groups was 143.7±24.3 and 130.6±26.5min, (p=0.11), and the mean hospital stay was 3.8±0.8 versus 4.2±1.4days in the two groups (p=0.06), respectively. Three and four complications were recorded in the LESS-RN and in the LRN groups, for a mean complication rate of 12 and 12.9% (p=0.12), respectively All tumours were organ-confined with negative surgical margins, and the mean R.E.N.A.L nephrometry score for LESS-RN and LRN was 9.78±1.7 and 9.82±1.3 (p=0.14), respectively. LESS-RN in patients with increased comorbidities and previous abdominal surgery is equally effective as LRN without compromising on surgical, oncologic short-term and postoperative outcomes.

Cornual resection for interstitial pregnancy by laparoendoscopic single-site surgery

To present two cases of interstitial pregnancy treated successfully by use of laparoendoscopic single-site surgery (LESS). Case series. Department of obstetrics and gynecology at a tertiary health care facility. Two women with interstitial pregnancy requiring surgical treatment. Laparoscopy by use of LESS with the single-incision laparoscopic surgery (SILS) system. Feasibility of LESS with the SILS system. Two patients were treated successfully by use of LESS with the SILS system. After laparoscopic confirmation of the interstitial pregnancy, a cornual resection was performed with bipolar forceps and scissors for the first patient and with an automatic stapler for the second. Laparoscopic treatment of interstitial pregnancy by use of LESS seems feasible. Larger series are necessary to confirm these findings.

Laparoendoscopic single-site surgery versus conventional laparoscopic surgery for adnexal tumors: A comparison of surgical outcomes and postoperative pain outcomes

The objective of this study was to show the feasibility of laparoendoscopic single-site surgery (LESS) by comparing the surgical outcomes and postoperative pain of LESS with conventional laparoscopic surgery (CLS) for gynecologic adnexal tumor. This is a prospective case–control study. We enrolled 33 patients—one in 18 patients for LESS and the other in 15 patients for CLS—who were diagnosed with evident adnexal tumor consecutively from September 2009 to February 2010 and were performed by a single surgeon. In LESS, all procedures were performed successfully without any case of conversion to CLS. There were no differences in the demographic characteristics between the two groups. The pathological findings were similar in both groups; a mucinous cystadenoma was the most common pathological feature. The most common operative type performed was cystectomy (22/33, 66%). There were no differences between the LESS and CLS groups in median operation time (62.8 minute vs. 51.3 minutes, p = 0.073); estimated blood loss during operation (100 mL vs. 128 mL, p = 0.068); and postoperative pain intensity measured by visual analog scale. There were no major complications in either group, including operative wound complications. Our study suggested that LESS for adnexal tumor is a feasible surgical technique through the comparable data of the surgical outcomes and postoperative pain outcomes.

Single-Port Laparoscopy, NOTES, and Endoluminal Surgery

Minimally invasive surgery has become the standard treatment for many disease processes. In the last decade, numerous studies have demonstrated that laparoscopic approaches to various conditions have improved the quality of life with comparable surgical and oncologic outcomes to standard open procedures. Recently, an alternative to conventional laparoscopy or robotic surgery has been developed: laparoendoscopic single-site surgery (LESS), also known as single-port surgery. Single-port laparoscopy is an attempt to further enhance the cosmetic benefits of minimally invasive surgery while minimizing the potential morbidity associated with multiple incisions. In this special issue, we will focus on 2 articles relevant to the advancement and practice of LESS. This new modality presents unique challenges, such as instrument crowding and the need to move and control a flexible camera and articulating instruments together, requiring even more advanced laparoscopic skills. Information about training and education on single-port laparoscopy is scarce in the current literature: Ramalingam et al. present their initial experience and methodology in training and education regarding this new technique. Formal training in this technique is not widely available. Expensive ports and instrumentation may be factors deterring the training. The authors address a major gap in the literature, how to train surgeons in this technique? They modified the standard laparoscopic endotrainer with improvised ports, to make it suitable for single-port laparoscopic training. For the animal lab training, they improvised ports and low-cost instruments. Thus, the overall cost of the training in LESS was reduced, and better confidence levels were achieved prior to human applications. Perhaps this will stimulate others to look at adopting this relatively low-tech technique for training in LESS. Emerging data on LESS has been reported in general surgical, gynecologic, and urologic procedures. LESS, for renal surgery, was first reported in 2007, and, since then, a handful of authors have described variations of their techniques. Derweesh and coauthors present the first prospective report in the literature of LESS radical nephrectomy with renal vein thrombectomy and cytoreductive nephrectomy. As such, this report further corroborates that increasingly complex procedures can be safely performed with the LESS platform. The feasibility of LESS for complex surgical procedures is no longer an issue. Current research and development in single-port robotics is ongoing. A single-port robotic platform may overcome technical limitations of single-site surgery (instrument crowding, lack of triangulation, and loss of depth of perception/instability with current 2D flexible optics). More importantly, it may play an essential role in the reproducibility and diffusion of LESS. Prospective studies are needed to assess the relative benefits of LESS compared with more conventional minimally invasive approaches. Pedro F. Escobar Jihad H. Kaouk Daniel Geisler Matthew Kroh Amanda Nickles Fader Tommaso Falcone

Laparoendoscopic Single-Site and Conventional Laparoscopic Adrenalectomy: A Matched Case–Control Study

The purpose of this study was to describe our initial clinical experience and assess the feasibility of laparoendoscopic single-site surgery (LESS) in the treatment of benign adrenal adenoma. Nine patients undergoing LESS adrenalectomy for benign adrenal adenoma were compared with 17 patients undergoing conventional laparoscopic adrenalectomy. Controls were matched for age, sex, surgical indications, and tumor size via a statistically generated selection of all conventional laparoscopic adrenalectomies performed during the same period of time. No significant differences in the mean operative time (169 vs. 144.5 minutes, p = 0.287), blood loss (177.8 vs. 204.7 mL, p = 0.792), and postoperative hospital stay (3.2 vs. 3.5 days, p = 0.525) were observed between the LESS and conventional laparoscopy group. However, postoperative pain, as measured by the number of days of intravenous (IV) patient controlled anesthesia use, was significantly lower in the LESS group (0.9 vs. 1.9 days, p = 0.047). Perioperative complications were similar between the two groups. LESS adrenalectomy for benign adrenal adenoma is comparable to the conventional laparoscopic approach with regard to the operative time, blood loss, length of hospital stay, and degree of complication, and has demonstrated more desirable cosmetic outcomes.

Laparoendoscopic Single-Site Surgery (LESS) in Gynecologic Oncology: Technique and Initial Report

article i nfo Objectives. Recent reports suggest that laparoendoscopic single-site surgery (LESS), also known as single- port surgery, is technically feasible in treating a variety of disease processes. The purpose of this study was to assess the feasibility of LESS for the surgical treatment of various gynecologic cancers or precancerous conditions through both laparoscopic and robotic-assisted approaches. Methods. A single institution retrospective review of patients treated with LESS on the gynecologic oncology service in 2009 was performed. Patients underwent surgery through a single 2-3 cm umbilical incision with a multi-channel SILS™ port for laparoscopic cases or a single-channel Gelport® for robotic cases on the daVinci® Surgical System. Results. Thirteen patients had LESS surgery performed, nine done laparoscopically and four robotically. Procedures included endometrial cancer staging (n= 1), ovarian cancer staging (n= 1), retroperitoneal pelvic lymph node dissection (n= 1), risk-reducing extrafascial hysterectomy/bilateral salpingo-oophor- ectomy (BSO, n= 2) and BSO alone (n= 5), and an ovarian cystectomy (n= 1) and BSO (n= 2) for complex adnexal masses. Median patient age and BMI were 47 years and 28, respectively. Median operating time was 65 min. All procedures were successfully performed via a single incision and no post-operative complications occurred. The majority of patients required no narcotics post-operatively. Conclusion. We present the first series of laparoendoscopic single-site surgery for the treatment of various gynecologic oncology conditions. LESS is feasible in select patients by laparoscopic or robotic-assisted techniques. Further studies are needed to better define the ideal gynecologic procedures for single-site surgery and to assess the benefits of LESS compared with more conventional minimally invasive approaches.

Editorial Comment

We applaud the authors for their work in assessing the applicability of laparoendoscopic single-site surgery (LESS). This approach is a more practical alternative to pure natural orifice transluminal endoscopic surgery (NOTES). Several previous studies have demonstrated the feasibility of LESS in urology, for both extirpative and reconstructive surgeries.1,2 The current series reviews to a considerable extent the safety and reproducibility of this technique. It should be pointed out, however, that in a significant proportion of these cases, the surgery described was not true “single-site surgery.” The authors note that all reconstructive cases (including partial nephrectomy, pyeloplasty, etc.) involved the use of an additional 2-mm trocar with accompanying instruments to complete these procedures.

Laparoendoscopic single-site surgery (LESS) in gynecologic oncology: Technique and initial report

Objectives Recent reports suggest that laparoendoscopic single-site surgery (LESS), also known as single-port surgery, is technically feasible in treating a variety of disease processes. The purpose of this study was to assess the feasibility of LESS for the surgical treatment of various gynecologic cancers or precancerous conditions through both laparoscopic and robotic-assisted approaches. Methods A single institution retrospective review of patients treated with LESS on the gynecologic oncology service in 2009 was performed. Patients underwent surgery through a single 2–3 cm umbilical incision with a multi-channel SILS™ port for laparoscopic cases or a single-channel Gelport® for robotic cases on the daVinci® Surgical System. Results Thirteen patients had LESS surgery performed, nine done laparoscopically and four robotically. Procedures included endometrial cancer staging ( n = 1), ovarian cancer staging ( n = 1), retroperitoneal pelvic lymph node dissection ( n = 1), risk-reducing extrafascial hysterectomy/bilateral salpingo-oophorectomy (BSO, n = 2) and BSO alone ( n = 5), and an ovarian cystectomy ( n = 1) and BSO ( n = 2) for complex adnexal masses. Median patient age and BMI were 47 years and 28, respectively. Median operating time was 65 min. All procedures were successfully performed via a single incision and no post-operative complications occurred. The majority of patients required no narcotics post-operatively. Conclusion We present the first series of laparoendoscopic single-site surgery for the treatment of various gynecologic oncology conditions. LESS is feasible in select patients by laparoscopic or robotic-assisted techniques. Further studies are needed to better define the ideal gynecologic procedures for single-site surgery and to assess the benefits of LESS compared with more conventional minimally invasive approaches.

Laparoscopic single-site surgery for placement of an adjustable gastric band: initial experience

Laparoendoscopic single-site (LESS) surgery for cholecystectomy and appendectomy are described in the literature. The benefits of these procedures compared with traditional laparoscopic approaches have yet to be determined. To date, no series of LESS surgeries for placement of an adjustable gastric band has been published or documented. This study aimed to determine the safety and feasibility of LESS surgery for placement of an adjustable gastric band. From December 2007 to June 2008, LESS surgery to place an adjustable gastric band via a transumbilical incision was performed for 10 patients with institutional review board approval. Essentially, multiple ports were placed through a single incision in the umbilicus to allow for liver retraction, visualization, and working instruments. All critical steps using a standard pars flaccida technique were performed without alteration. For this study, 10 patients (9 women and 1 man) were carefully selected. These patients ranged in age from 32 to 61 years (mean, 47 years) and had a mean body mass index (BMI) of 42 kg/m2 (range, 35-45 kg/m2). The patients were selected for absence of both hepatomegaly and central obesity. Superobese patients were not considered for inclusion in the study. The mean operative time was 1 h and 10 min (range, 53 min to 1 h and 48 min). All the patients were discharged home within 23 h of admission, and no perioperative complications were noted. In addition, no wound-related complications occurred. Notably, only 2 of the 10 patients required the use of narcotic analgesia after discharge from the recovery room. There were no intra- or postoperative complications. In our experience, LESS surgery for adjustable gastric banding shows this technique to be both feasible and safe for selected patients. Although technical limitations exist that will be improved upon, further studies are needed to compare LESS surgery for placement of an adjustable gastric band with traditional laparoscopic techniques.