Laparoendoscopic Single-Site Surgery In Gynecology Research Articles

Prediction model of laparoendoscopic single-site surgery in gynecology using machine learning algorithm.

IntroductionMinimally invasive surgery has been widely used in gynecology. The laparoendoscopic single-site surgery (LESS) risk prediction model can provide evidence-based references for preoperative surgical procedure selection.AimTo determine whether the patients are suitable for LESS and to provide guidance for the clinical operation plan, we aimed to compare the clinical outcomes of LESS and conventional laparoscopic surgery (CLS) in gynecology. We constructed a LESS risk prediction model and predicted surgical conditions for the preoperative evaluation system.Material and methodsA retrospective analysis was carried out among patients undergoing LESS (n = 1019) and CLS (n = 1055). Various clinical indicators were compared. Multiple machine model algorithms were evaluated. The optimal results were chosen as the model to form the risk prediction model.ResultsThe LESS group showed advantages in the postoperative 12/24 h visual analog scale and Vancouver scar score compared with the CLS group (p < 0.05). The comparisons in other clinical indicators between the two groups showed that each group had advantages and the difference was statistically significant (p < 0.05), including operative time, estimated blood loss, and hospital stay. We evaluated the predictive value for various models using AUC values of 0.77, 0.77, 0.76, and 0.67 for XGBoost, random forest, GBDT, and logistic regression, respectively. The decision tree model was shown to be the optimal model.ConclusionsLESS can reduce postoperative pain, shorten hospital stay and make scars acceptable. The risk prediction model based on a machine learning algorithm has manifested a high degree of accuracy and can satisfy the doctors’ demand for individualized preoperative evaluation and surgical safety in LESS.

Internal Grasper and Magnetic Anchoring Guidance System in Gynecologic Laparoendoscopic Single-site Surgery: A Case Series

To evaluate and report preliminary data after the use of an internal grasper and magnetic anchoring guidance system (MAGS) to allow free movement and optimal triangulation in the abdominal cavity during gynecologic laparoendoscopic single-site surgery (LESS). A prospective, single-center case series. The First Affiliated Hospital of Xi'an Jiaotong University. Eighteen female patients underwent MAGS-assisted LESS with an internal grasper. A single surgeon performed MAGS-assisted LESS on patients with benign gynecologic diseases while documenting operative time, device insertion time, surgeon assessment of technical adaptation, patient-evaluated pain and cosmetic outcomes, adverse events, and blood loss. Eighteen patients underwent transumbilical MAGS-assisted LESS using an internal grasper from November 1, 2019, to December 31, 2019. The mean operative time and insertion time were 98.7 minutes and 1 minute, respectively. The use of MAGS was easily mastered by the surgeon and considered consistently useful in overcoming the limitations of LESS. The patients reported average pain scores of 4.8, 2.3, and 0.5 immediately, 24 hours, and 1 week after surgery, respectively. All patients expressed satisfaction with the postoperative cosmetic results. No serious complications were observed. The mean blood loss was 43.6 mL. MAGS-assisted LESS is easy to deploy and use for benign gynecologic disease and seems to result in positive outcomes. Larger randomized controlled trials are warranted.

The Current Situation of Gynecologic Laparoendoscopic Single-Site Surgery in a Chinese Teaching Hospital

The Current Situation of Gynecologic Laparoendoscopic Single-Site Surgery in a Chinese Teaching Hospital

Gynecologic Laparo-endoscopic Single-Site Surgery: Where do we Stand and what is on the Horizon?

Objective: The objective of this article is to review the current literature on laparo-endoscopic single-site (LESS) surgery in gynecology, discuss recent developments, and what is on the horizon for LESS surgery. Design: Appraisal of articles published on the use of laparo-endoscopic single-site surgery in gynecology from 2008 to the present. PubMed, Medline, and the Cochrane Central Register of Controlled Trials were systematically searched using the terms “laparo-endoscopic single-site”, “single-site laparoscopy”, “single port laparoscopy”, “SPA”, “SILS”, “LESS”, “robotic single-site surgery”, and “R-LESS” between January 1, 2016 and February 15, 2016. Publication date restrictions were all publications 2008 and later. Non-English language was excluded. Results: LESS and R-LESS is safe, feasible, and equivalent to traditional multiport laparoscopy and robotic surgery. Cosmesis is potentially the most obvious advantage associated with LESS surgery. Instrument crowding with associated external instrument space conflicts is a major problem since all the instruments are inserted through a single point on the abdomen. For the experienced laparoscopist, the learning curve for LESS is shorter and associated with less morbidity when compared to the learning curve of multiport laparoscopy. Conclusion: LESS surgery is another option of approach to minimally invasive gynecologic surgery. There is a clear body of literature demonstrating that LESS is feasible, safe, and equivalent to traditional multiport and robotic surgery. There is growing literature regarding improved cosmesis, improved pain control, quicker recovery, and shorter hospitalizations but these studies, even when combined, are underpowered. Both traditional and robotic laparoendoscopic single site surgeries are still in the early development and diffusion. Keywords: Laparo-endoscopic single-site, single-site laparoscopy, single port laparoscopy, LESS, robotic surgery, R-LESS.

Robotic laparoendoscopic single-site benign gynecologic surgery: a single-center experience.

The da Vinci Xi surgical system was released with several upgrades and modifications compared to the previous robotic generations to facilitate minimal invasive surgery. Herein, we present our preliminary experience of robotic laparoendoscopic single-site gynecologic surgery performed for benign indications with the da Vinci Xi robotic system in a single center. Thirty-five female patients underwent robotic single-site surgery between June 2016 and January 2017. The median console time for hysterectomy with or without salpingo-oophorectomy was 41min. The median intracorporeal vaginal cuff closure time was 18min. Two cases (5.7%) were converted to robotic-assisted multiport surgery. There was one major intraoperative complication (2.9%). None of the patient required blood transfusion. When comparing our first 12 cases to subsequent 12 cases of R-LESS hysterectomy, there was a statistically significant decrease in surgical times and estimated blood loss. On logistic regression analysis, no association was detected between BMI and port entry time (OR 0.93, 95% CI 0.83-1.04, p=0.23), console time (OR 0.98, 95% CI 0.94-1.02, p=0.37), cuff closure time (OR 0.9, 95% CI 0.76-1.09, p=0.33), operative time (OR 1, 95% CI 0.98-1.01, p=0.97), and estimated blood loss (OR 0.98, 95% CI 0.96-1.01, p=0.33). Our preliminary experience with robotic laparoendoscopic single-site surgery using the da Vinci Xi system has demonstrated feasibility and safety in select patients. Further studies with greater number of patients in multiple settings will help us to fully elucidate the role of da Vinci Xi surgical system in single-site gynecologic surgery.

Port site infiltration of local anesthetic after laparoendoscopic single site surgery for benign adnexal disease.

ObjectiveTo determine whether local bupivacaine injection into the incision site after gynecologic laparoendoscopic single site surgery (LESS) improves postoperative pain.MethodsThis prospective cohort study included consecutive 158 patients who had LESS for benign adnexal disease from March 2013 to December 2015. Chronologically, 82 patients (March 2013 to August 2014) received no bupivacaine (group 1) and 76 (August 2014 to December 2015) received a bupivacaine block (group 2). For group 2, 10 mL 0.25% bupivacaine was injected into the 20 mm-incision site through all preperitoneal layers after LESS completion. Primary outcome is postoperative pain score using the visual analog scale (VAS).ResultsThere was no difference in clinicopathological characteristics between the groups. Operating time (expressed as median [range], 92 [55–222] vs. 100 [50–185] minutes, P=0.137) and estimated blood loss (50 [30–1,500] vs. 125 [30–1,000] mL, P=0.482) were similar between the groups. Post-surgical VAS pain scores after 3 hours (3.5 [2–6] vs. 3.5 [2–5], P=0.478), 6 to 8 hours (3.5 [2–6] vs. 3 [1–8], P=0.478), and 16 to 24 hours (3 [2–4] vs. 3 [1–7], P=0.664) did not differ between groups.ConclusionBupivacaine injection into the trocar site did not improve postoperative pain after LESS. Randomized trials are needed to evaluate the benefits of local bupivacaine anesthetic for postoperative pain reduction.

Feasibility and Learning Curve of Robotic Laparoendoscopic Single-Site Surgery in Gynecology

Single-site laparoscopy has proven to be a desirable option for patients undergoing gynecologic surgery, with some studies indicating improved cosmesis and less perioperative pain compared with standard approaches. This study describes the safety and feasibility of a novel robotic laparoendoscopic single-site surgery (R-LESS) platform as it is incorporated into a surgeon's practice with extensive multiport robotic surgical experience but limited LESS experience. We reviewed 83 women undergoing R-LESS by a single surgeon from September 2013 through August 2015. Operative times (total operative time, console time, docking time) were collected prospectively for the first 53 cases, and total operative time was collected retrospectively for the next 30 cases. Clinical parameters, including age, estimated blood loss, body mass index (BMI), prior abdominal surgeries, conversion to laparotomy, procedure type, uterine weight, length of hospital stay, and complications, were retrospectively collected from medical charts. Eighty-two of 83 surgeries were completed successfully with a single incision. One surgery was converted to multiport robotics for para-aortic lymph node dissection. Twelve surgeries were performed for cancer (ovary 1, uterus 8, and cervix 3). Eight patients underwent pelvic lymph node biopsy. The median total operative time for hysterectomies was 128 minutes (range, 60–275). After the first 13 hysterectomies the total operative time and the console time decreased significantly from 165.3 to 131.1 minutes (p = .032) and from 84.9 to 57.1 minutes (p = .028), respectively. Mean docking time halved from 7.8 minutes to 3.4 minutes comparing the first 10 cases to the last 10 cases. Surgical times were longer with larger BMIs, but the console time decreased with experience regardless of BMI. The mean uterine weight was 164 g (range, 30–460). Complications included 2 umbilical hernias (2.4%) and 1 conversion to multiport. In conclusion, R-LESS is a feasible and safe surgical platform for gynecologic procedures. A small number of cases are needed to significantly improve operative times when it is introduced on a surgeon's practice with limited experience in LESS but familiar with robotic surgery. Further study is needed to investigate the cost, benefits, and long-term outcomes of R-LESS.

Consensus on gynecologic laparoendoscopic single site surgery

Consensus on gynecologic laparoendoscopic single site surgery

Ovarian Suspension With Adjustable Sutures: An Easy and Helpful Technique for Facilitating Laparoendoscopic Single-Site Gynecologic Surgery.

To describe a method of ovarian suspension with adjustable sutures (OSAS) for facilitating laparoendoscopic single-site gynecologic surgery (LESS) and to investigate the effect of OSAS on LESS. Prospective cohort study (Canadian Task Force classification: II-2). University teaching hospital. One hundred seventy-eight patients with benign 5- to 15-cm cystic ovarian tumors who underwent LESS with OSAS (suspension group, n = 90) and without OSAS (control group, n = 88). For patients who underwent OSAS (suspension group), 1 end of double-head straight needles with a polypropylene suture was inserted into the pelvic cavity through the abdominal skin to penetrate the cyst or ovarian parenchyma and puncture outside the abdominal skin. After cutting off the needles, both sides of the remaining suture were held together by a clamp, without knotting, so that the manipulator could "lift," "loosen," or "fix" the stitches to adjust the tension. The average time to create OSAS was 2.9 min. For the suspension and control groups, the average blood loss was 81.4 and 131.8 mL (p < .001), and the operative time was 42.0 and 61.3 min (p < .001), respectively. There were no significant differences in the incidence of complications (5.6% vs 9.1%; p = .365), but there were significant differences in conversions to standard non-single-site laparoscopy (5.6% vs 15.9%; p = .025) and laparotomy (1.1% vs 6.8%; p = .040). Logistic regression analysis revealed that the ratios of conversion to standard non-single-site laparoscopy (odds ratio [OR], 0.126; 95% confidence interval [CI], 0.311-0.508) and laparotomy (OR, 0.032; 95% CI, 0.002-0.479) were much lower in the suspension group; the risk of complications was comparable (OR, 0.346; 95% CI, 0.085-1.403). OSAS is an easy, safe, and feasible method that offers advantages during LESS. Although routine use of OSAS is not necessary, OSAS can be considered during LESS to facilitate the surgery.

Public perception of "scarless" laparoendoscopic single-site surgery in gynecology.

ObjectiveTo investigate the public perception of laparoendoscopic single-site surgery (LESS) according to the age group.MethodsAn anonymous questionnaire about the desire for cosmesis and the preference for LESS in treatment of benign gynecologic diseases was provided to healthy volunteers (n=102). The survey participants were divided into two age groups (young women ≤40 years and middle-aged women >40 years). The desire for cosmesis was assessed using a validated scale, Body Image Scale.ResultsAll of the participants completed the questionnaire. The Body Image Scale scores were not different between the two age groups (11.5±3.5 vs. 11.8±4.0, P=0.656). The most common fear of surgery was the risk of complications in both age groups (69% in the young age group and 65% in the middle-aged group). Unless the operative risk increased, most of the participants (61% to 67%) in both age groups preferred LESS. Their choice was influenced by reduced scarring (43% to 61%), more safety (20% to 39%), reduced postoperative pain (8% to 10%), and new technology (4% to 6%).ConclusionBased on these results, there was no difference in the desire for cosmesis and perception of LESS according to the age. Therefore, physicians should discuss and consider LESS even in middle-aged women.

Changing our view of minimally invasive gynecologic surgery: A review of laparoendoscopic single-site surgery and a report on new approaches

The recent emergence of laparoendoscopic single-site surgery (LESS) has had a great impact on gynecology. As LESS grows in popularity, attention has been paid to the procedure's cosmetic benefits. Although in theory LESS is an ideal approach that leaves no visible scars and improves patients' quality of life, the outcomes are not always ideal according to recently published data. Therefore, alternative approaches, such as mini-laparoscopy, are also becoming more popular. Herein, we review randomized trials studying the benefits of LESS in gynecology and discuss alternative approaches. Finally, we propose the mimic approach as the next generation for non-visible scar surgery.

Laparoendoscopic Single-Site Surgery in Gynecology

Recent decades have witnessed a tremendous shift from laparotomy to laparoscopy as the surgical approach of choice in gynecology. Completion of increasingly complicated procedures has been facilitated by technical advances in instrumentation. Lately, increasing attention has been paid to reducing both the number and size of laparoscopic incisions, with the ultimate goal being the absence of any visible scar. Laparoendoscopic single-site surgery (LESS), or single-incision laparoscopy, describes the use of 1 small skin incision to complete laparoscopic surgical procedures where traditionally multiple incisions were created. In addition to examining the developing literature related to LESS in gynecology, the aims of this review were to describe the technical challenges encountered during performance of LESS and to provide practical solutions for instrumentation and surgical techniques that allow them to be overcome. Obstetricians and gynecologists, family physicians After completing this CME activity, physicians should be better able to identify potential benefits of LESS, and implement practical solutions for instrumentation and surgical techniques to overcome technical challenges faced during LESS.

Laparoendoscopic single-site surgery in gynecology: Dawn of a new era

Laparoendoscopic single-site surgery in gynecology: Dawn of a new era

Laparoendoscopic single-site surgery in gynecology: LESS is actually how much less?

Gynecological surgery is evolving continuously. Laparoendoscopic single-site surgery (LESS) is the recent addition in this field that stands to benefit almost 40% of women in midlife who will eventually undergo adnexal surgery or hysterectomy. Carried out through a single umbilical incision, the potential benefit of single site surgery is improvement in operative morbidity and cosmesis. The safety, feasibility and efficacy of laparoendoscopic single site procedures have been established in studies over the last few years. In this article, we will review the nomenclature, instruments, and the evidence around the commonly performed gynecologic surgeries using the LESS procedure.

The Risk of Umbilical Hernia and Other Complications with Laparoendoscopic Single-Site Surgery

Study Objective To estimate the risk of umbilical hernia and other latent complications in women who underwent laparoendoscopic single-site surgery (LESS) for a gynecologic indication. Design Retrospective, nonrandomized clinical study (Canadian Task Force classification II-2). Setting Four tertiary care academic medical centers. Patients Women undergoing LESS for a benign or malignant gynecologic indication from 2009 to 2011. Interventions A total of 211 women underwent LESS via a single 1.5- to 2.0-cm umbilical incision. All surgeries were performed by advanced gynecologic laparoscopists. Incisions were repaired with a running, delayed absorbable suture. Subject demographics and clinical variables were collected and surgical outcomes analyzed. Measurements and Main Results Median age and body mass index were 45 years and 30 kg/m 2, respectively. Approximately half of study subjects underwent a hysterectomy with or without salpingo-oophorectomy, and 15% had a diagnosis of cancer. Overall, 0.9% of women were diagnosed with a preoperative umbilical hernia, and 2.4% of women experienced a major perioperative complication. After a median postoperative follow-up time of 16 months, 2.4% had development of an umbilical hernia. However, 4/5 of these women had significant risk factors for fascial weakening independent of LESS, including requirement for a second abdominal surgery in 1 subject and a cancer diagnosis with postoperative chemotherapy administration in 2 subjects. When these subjects deemed “high risk” for incisional disruption were excluded from the analysis, the umbilical hernia rate was 0.5% (1/207). On univariable analysis, obesity was the only factor associated with complications (p = .04). Conclusion When performed by advanced laparoscopic surgeons, laparoendoscopic single-site gynecologic surgery is associated with a low risk of major adverse events. Additionally, the overall umbilical hernia rate was 2.4% and was lower (0.5%) in subjects without significant comorbidities.

Evaluation of Laparoendoscopic Single-site Gynecologic Surgery with a Multitrocar Access System

Laparoendoscopic single-site surgery (LESS) is an ideal approach for gynecologic surgery and yields better cosmetic results. However, a standard umbilical approach with LESS is not appropriate for gynecologic surgery requiring intra-abdominal suturing and dissection requiring traction. Therefore, we have developed a new multitrocar access system for gynecologic LESS. The purpose of this study was to evaluate the efficacy of gynecologic LESS using this access system. This access system consists of one 12-mm trocar, two 5-mm trocars, and a 5-mm flexible laparoscope. Two 5-mm trocars with small port heads were inserted cross-wise on opposite sides of the sleeve of the centrally positioned 12-mm trocar to maintain triangulation. Thirty-eight patients with various gynecologic conditions underwent LESS with this access system. The results of these surgeries were retrospectively compared to those of conventional laparoscopic procedures. Of the 38 LESS procedures performed with this access system, none was up-converted, converted to an open laparotomy, or required blood transfusion. The Salpingo-oophorectomy with LESS had several benefits, such as no extension of the skin incision of the trocar site and no leakage of the contents of the ovarian cyst into the peritoneal cavity, over that with conventional laparoscopy. A comparison of LESS (11 patients) and conventional laparoscopy (16 patients) for total hysterectomy showed no significant difference in total blood loss (234.0 mL vs. 221.6 mL) or the weight of the resected uterus (276.0 g vs. 285.0 g), although the mean total operative time was greater with LESS (199.0 min vs. 168.5 min). Our multitrocar access system is safe and secure, and can be adapted for various gynecologic surgeries involving complicated procedures. LESS with this access system achieves results comparable to those of conventional laparoscopy with 4 ports, although the operative time is longer.

Laparo-Endoscopic Single-Site Surgery in Gynecology – A Review of the Literature and Available Technology

Study Objective: The goal of this article is to review the published literature on Laparo-endoscopic single-site surgery (LESS) in gynecology and to present current advances in instruments for LESS surgery.

Laparoendoscopic single-site surgery in gynecology

To review the contemporary literature on laparoendoscopic single-site surgery (LESS) advances in gynecology. Minimally invasive surgery has become a standard of care for the treatment of many benign and malignant gynecologic conditions. Both conventional laparoscopy and robotic assisted surgery have impacted the entire spectrum of gynecologic surgery. Ongoing efforts to improve upon the morbidity and cosmetic sequelae of laparoscopic surgery have led to minimization of size and number of ports required for these procedures. LESS surgery is a recently coined surgical term used to describe various techniques that aim at performing laparoscopic surgery through a single, small skin incision concealed within the umbilicus.LESS surgery is not a new endeavor but recent developments in surgical technology and techniques have resulted in an exponential increase in utilization of LESS across many surgical subspecialties. Recently published outcome data demonstrate feasibility, safety and reproducibility for LESS in gynecology. The contemporary LESS literature, gamut of gynecologic procedures and limitations of current technology will be reviewed in this article. LESS represents the latest innovation in minimally invasive surgery but comparative data and prospective trials are required to determine the clinical impact of LESS in treatment of gynecologic conditions.

Robotic-Assisted Laparoendoscopic Single-Site Surgery in Gynecology: Initial Report and Technique

Robotic surgery has greatly improved surgeon dexterity and ergonomics but has substantially increased the number and size of ports required. The typical robotic surgical procedure will use three 8-mm ports and two 12-mm ports. Single-port laparoscopy, also known as Laparo-Endoscopic Single Site (LESS) surgery, is an attempt to further enhance cosmetic benefits and reduce morbidity of minimally invasive surgery.We present our initial clinical experience and technique with robotic-assisted single-port surgery in gynecology.