Laparoendoscopic Single-site Research Articles

Cervicovaginal reconstruction with small intestinal submucosa graft in congenital cervicovaginal atresia: A report of 38 cases

ObjectiveTo evaluate the quality of life and surgical outcomes in patients with congenital cervicovaginal malformation after cervicovaginal reconstruction. Study designThirty-eight patients diagnosed with congenital cervicovaginal aplasia and underwent cervicovaginal reconstruction using acellular porcine small intestinal submucosa (SIS) grafts were included in the study from January 2012 to December 2019. Of these, twenty-one patients underwent conventional laparoscopy, nine underwent robotic surgery, and eight underwent laparoendoscopic single-site (LESS) surgery. Clinical characteristics, perioperative data, condition of the neovagina and neocevix, post-operation complications, body image, resumption of menstruation, sexual function, and quality of life were assessed. ResultsThe average age of the patients was 16.4 ± 5.78 years. The operative procedure lasted 182.29 ± 70.85 min, with a hemoglobin decrease of 12.53 ± 7.55 g/dl. All surgery was completed successfully without complications. The total cost was highest in the robotic surgery group (P < 0.001). The cosmetic scores were significantly higher in the LESS group (P < 0.001). At a median follow-up of 49.79 ± 31.02 months, all patients resumed menstruation, except one patient who underwent hysterectomy due to vaginal obstruction. The average length of neovagina was 8.11 ± 0.75 cm, and the length of the cervix was 1.73 ± 1.00 cm. There were one patient with vaginal stenosis, two patients with cervical occlusion, two patients with cervical stenosis, and six patients with intrauterine device loss. Fourteen patients experienced sexual activity, with the total female sexual function index scores of 26.83 ± 3.49. Six patients had a desire of pregnancy, and one patient had pregnant via assisted-reproduction techniques. No differences in the mean physical component score (PCS) and mental component score (MCS) were identified among three different groups at baseline and all post-surgery time points (P > 0.05), but with the extension of follow-up, both PCS and MCS increased significantly in all groups (P < 0.001). ConclusionCervicovaginal reconstruction using an SIS graft is safe and efficient to the management of congenital cervicovaginal atresia whatever by the conventional laparoscopy, robotic surgery or LESS, with good surgical outcomes and high of quality of life.

Retroperitoneoscopic debridement and internal fixation for the treatment of lumbar tuberculosis.

To describe the retroperitoneoscopic debridement technique and evaluate the clinical outcome of internal fixation for the treatment of lumbar tuberculosis.Twenty-eight patients were performed conventional laparoendoscopic technique (n = 17) or laparoendoscopic single-site technique (n = 11). Antituberculosis chemotherapy and thoracolumbosacral orthosis were given to all patients. The clinical outcomes were evaluated with preoperative and postoperative Visual Analog Scale, and radiographs with respect to sagittal angle and fusion status.Average time of the 28 procedures was 220.6 ± 50.9 min (180–365 min). The average intraoperative blood loss was 108.6 ± 95.3 mL (50–400 mL). All patients showed significant improvement of their Visual Analog Scale back pain score at follow-up and were classified as having a radiographic fusion in this study. The mean sagittal angle was 11.2 ± 3.6° before operation, significantly improved to 3.7 ± 2.4° after operation. There were no recurrent infections during the follow-up period. Complications included loosening of anterior fixation and temporary deficit of the sympathetic nerve.Retroperitoneal laparoscopic approach with CO2 insufflation technique is a challenging but safe and effective procedure for lumbar spine tuberculosis. Retroperitoneal laparoendoscopic single-site can be used for anterior lumbar spine surgery, offer exposure for L1 through L5.

Separación del sistema de imagen del dispositivo de cirugía laparoendoscópica de puerto único en cirugía endoscópica uniportal: proyecto ZEUS

The use of a rigid tube endoscope (RTE) through a laparoendoscopic single site surgery device for intracavitary visualization during endoscopic uniportal surgery (EUS) is directly related to the fulcrum effect and physical competition (externally between surgeons and on instrumentation through the single port). These facts may have precluded a wider spread of EUS. In an attempt to separate the imaging system from the laparoendoscopic single site surgery device, a tiered project (3 models) that can help overcome these drawbacks is detailed. ZEUS1, a new non-RTE imaging system device for EUS was successfully tested in EUS surgery in a pig model. Still under investigation, ZEUS2 becomes a wired structure that serves as the basis for an endoscopic microcamera with intracavitary pan-tilt-zoom functions. ZEUS3 uses the inner ring of the surgical wound protector as a microchamber crown. Further studies are needed to materialize the ZEUS2 and ZEUS3 models and confirm their efficacy and safety.

Longitudinal analysis of retroperitoneoscopic adrenalectomy regarding cosmesis outcomes: comparison of lateral transperitoneal and reduced port laparoscopic adrenalectomy.

The aim of this study is to compare patient-reported cosmesis and satisfaction outcomes between lateral retroperitoneoscopic adrenalectomy (LRA), laparoendoscopic single site and reduced port adrenalectomy (LESS/RP-A) and lateral transperitoneal laparoscopic adrenalectomy (LTA). A total of 26, 86 and 50 patients who underwent LRA, LESS/RP-A and LTA were included in the study. All LESS/RP-A cases were performed taking the transumbilical approach. We mailed a questionnaire to all patients 1, 3, 6, 9 and 12months after operation. Questionnaires inquiring about cosmesis (0: very ugly, 10: very beautiful) on the basis of a visual analogue scale were administered. The mean scores of cosmesis at postoperative months 1, 3, 6, 9 and 12 were 7.11, 7.00, 6.57, 5.25 and 5.46 for the LRA group, 8.43, 8.86, 8.95, 8.46 and 9.09 for the LESS/RP-A group and 7.18, 7.74, 7.58, 7.44 and 8.09 for the LTA group. The difference in cosmesis score between the LRA and LESS/RP-A groups gradually increased after surgery, and the cosmesis score for the LRA group was significantly lower at every postoperative point. The difference in cosmesis score between the LRA and LTA groups gradually increased after surgery, and the cosmesis score for the LRA group was significantly lower at postoperative months 9 (p = 0.015) and 12 (p = 0.002). This study is the first comprehensive longitudinal analysis of patient-reported cosmesis outcomes between LRA, LESS/RP-A and LTA. LRA was the surgical procedure that resulted in lower cosmesis scores when compared with those following the LESS/RP-A and LTA procedures.

V08-12 Y-SHAPED INCISIONS AND THREE-FLAP UMBILICOPLASTY: A NOVEL LAPAROENDOSCOPIC SINGLE-SITE SURGICAL APPROACH FOR PATIENTS WITH SYMPTOMATIC URACHAL SINUS

You have accessJournal of UrologyNOTES/LESS (V08)1 Sep 2021V08-12 Y-SHAPED INCISIONS AND THREE-FLAP UMBILICOPLASTY: A NOVEL LAPAROENDOSCOPIC SINGLE-SITE SURGICAL APPROACH FOR PATIENTS WITH SYMPTOMATIC URACHAL SINUS Hakushi Kim, Masahiro Nitta, Masanori Hasegawa, Yoshiaki Kawamura, Sunao Shoji, Hidenori Zakoji, and Akira Miyajima Hakushi KimHakushi Kim More articles by this author , Masahiro NittaMasahiro Nitta More articles by this author , Masanori HasegawaMasanori Hasegawa More articles by this author , Yoshiaki KawamuraYoshiaki Kawamura More articles by this author , Sunao ShojiSunao Shoji More articles by this author , Hidenori ZakojiHidenori Zakoji More articles by this author , and Akira MiyajimaAkira Miyajima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002041.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Symptomatic urachal sinuses are rare benign anomalies that affect young adults. Surgical intervention is necessary for curative treatment, but acceptable postoperative esthetic outcomes are also required in young patients. In recent years, laparoscopic surgery has largely replaced the open surgical approach and cosmetic outcomes have improved. We describe a novel laparoendoscopic single-site (LESS) surgical approach using Y-shaped incisions and three-flap umbilicoplasty to improve repair and esthetic outcomes. METHODS: We retrospectively evaluated 51 patients diagnosed with symptomatic urachal remnants at our institution between December 2014 and September 2020. We included 34 men and 17 women with a mean age of 27 years in this study. The clinical and perioperative data and esthetic outcomes of 51 patients who underwent LESS surgery were investigated. Body image and cosmesis of each patient after surgery were assessed subjectively using a self-assessment body image questionnaire (BIQ). RESULTS: The median operative time and the median insufflation time were 144 minutes (66–297 minutes) and 45 minutes (11–188 minutes), respectively. The median estimated blood loss and postoperative hospital stay were 5 mL (0–128 mL) and 4 days (2–13 days), respectively. The median body image and cosmesis scores after surgery were 19/20 and 21/24, respectively. Pictures of preoperative and postoperative umbilical appearances are depicted (Figure). CONCLUSIONS: Our novel LESS approach showed surgical feasibility for symptomatic urachal sinus. Moreover, the high postoperative BIQ scores indicated good perception of body image change and good satisfaction with postoperative cosmetic outcomes of this technique. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e604-e605 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hakushi Kim More articles by this author Masahiro Nitta More articles by this author Masanori Hasegawa More articles by this author Yoshiaki Kawamura More articles by this author Sunao Shoji More articles by this author Hidenori Zakoji More articles by this author Akira Miyajima More articles by this author Expand All Advertisement Loading ...

Comparison of Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) and Laparoendoscopic Single-Site (LESS) Hysterectomy on PostoperativePain Reduction: A Randomized Pilot Study.

IntroductionVaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy has shown benefit in postoperative pain and operation time compared to laparoscopic hysterectomy in recent studies. However, no prospective studies comparing laparoendoscopic single-site (LESS) and vNOTES hysterectomy have been performed. This study aims to evaluate postoperative pain and safety of vNOTES hysterectomy compared to LESS hysterectomy for benign uterine disease.MethodsThis study is a prospective, investigator-initiated randomized controlled pilot trial. A total of 26 patients were randomized and allocated to vNOTES group (n = 13) and LESS group (n = 13). The primary outcome was postoperative abdominal and vaginal pain evaluated 24 h after surgery. Secondary outcomes included the number of additional analgesics administered and the maintenance rate of patient-controlled analgesia (PCA).ResultsNo differences were shown in baseline characteristics between the two groups. Operation time was longer in the LESS group (median, 55 vs. 75 min; P = 0.027), and there were no differences in estimated blood loss, postoperative hemoglobin level, surgical indications, and hospitalization days. Postoperative abdominal pain intensity did not differ between the two groups, while the vNOTES group showed higher postoperative vaginal pain than the LESS group at 16 and 24 h after surgery (median, 3 vs. 1 and 2 vs. 0, P = 0.007 and P = 0.010, at 16 and 24 h respectively). No differences were shown in the number of additional analgesics and PCA use between the two groups.ConclusionsvNOTES hysterectomy can be safely performed for benign uterine disease requiring hysterectomy. However, vNOTES hysterectomy might be associated with higher postoperative vaginal pain intensity compared to LESS hysterectomy.Trial RegistrationCRIS identifier KCT0004605.

Laparoendoscopic Single Site Hysterectomy: Literature Review and Procedure Description.

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.

A randomized controlled trial of ovarian reserve preservation and hemostasis during ovarian cystectomy

The preservation of ovarian reserve during laparoendoscopic single-site (LESS) ovarian cystectomy is crucial for reproductive-age women. This study was a single-blinded, single-center, and randomized controlled trial to evaluate the effect of hemostatic agents on the preservation of ovarian reserve and hemostasis during LESS ovarian cystectomy. Patients with unilateral ovarian cyst were randomized to the hemostatic agent and coagulation groups according to the hemostasis method. Afterwards, the patients underwent LESS ovarian cystectomy, and hemostasis was performed after ovarian cyst excision according to the assigned hemostasis method. If hemostasis was not completed within 10 min. After discharge, the patients were followed until 3 months after surgery. We compared the hemoglobin, anti-Müllerian hormone (AMH) levels, and ovarian volumes before surgery, and 2 days, 1 week, and 3 months after surgery (3 M-POST), and the decline ratio between the two groups. The decline ratio of serum AMH levels was greater at 3 M-POST in the coagulation than in the hemostatic agent group (median intention-to-treat [ITT], − 36.7 vs. − 13.3%; per-protocol [PP], − 36.8 vs. − 13.3%; P < 0.05). Notably, the difference of the decline ratio of serum AMH levels was only shown in endometriosis patients (median; ITT, − 50.7 vs. − 14.4%; PP, − 50.7% vs. − 14.4%; P < 0.05), while there was no difference in non-endometriosis patients. In conclusion, Hemostatic agents may be non-inferior to bipolar coagulation for preserving ovarian reserve and hemostasis during LESS ovarian cystectomy, in particular, for endometriosis patients. (Trial registry: ClinicalTrials.gov Identifier NCT03374397).

Chopstick technique used in laparoendoscopic single site radical hysterectomy for early stage cervical cancer

Laparoendoscopic single-site surgery (LESS) further minimizes the invasiveness of traditional laparoscopic surgery. However, the "chopstick" effect caused by the parallel arrangement of the instruments in the umbilicus is considered an obstacle indelicate operations. The purpose of this study was to introduce a new technique characterized by a double fulcrum formed by instruments, named the "chopstick" technique, which facilitates the expedient accomplishment of complicated surgeries such as LESS radical hysterectomy (LESS-RH). Seventy-three patients who underwent LESS-RH using the "chopstick" technique were retrospectively analyzed. The procedure was performed successfully in 72 patients. The median operative duration was 225 min, and the median intraoperative blood loss was 200 ml. Among the operations in the first 20 patients, intraoperative vascular injuries and bladder injury occurred in two patients and were repaired by LESS. Patients responded positively regarding minimal postoperative pain control. The score of satisfaction with the cosmetic outcome expressed by the patients was eight at discharge and nine 30 days later. In conclusion, this study presents the feasibility of accomplishing complicated procedures, such as radical hysterectomy, by LESS using the “chopstick” technique. This approach provides more options for both selected patients and surgeons.

Comparison of Chief Surgeons' and Assistants' Feelings of Fatigue Between Laparoendoscopic Single-site and Conventional Laparoscopic Adrenalectomy.

Our objective was to compare the surgical staff's feelings of fatigue between laparoendoscopic single-site adrenalectomy (LESS-A) and conventional laparoscopic adrenalectomy (CLA) before and after surgery. Data were collected for surgical procedures performed between June 2011 and September 2017 (57 LESS-A and 37 CLA). Each procedure in both groups was performed by the same chief surgeon. The subjective fatigue feelings of the key members of the surgical team (chief surgeon, scopist, assistant surgeon) were assessed using the "Jikaku-sho shirabe" questionnaire, which contained questions about work-related feelings of fatigue. It consisted of 25 subjective items for 5 factors drawn from factor analysis (drowsiness, instability, uneasiness, local pain or dullness, and eyestrain). For each item, the participants were requested to estimate the intensity of their feelings using a five-point rating scale before and after surgery. There was no significant difference in operative time (p = 0.231) between the LESS-A and CLA procedure groups. For the chief surgeon, local pain or dullness (p = 0.603) and eyestrain (p = 0.086) were similar between the LESS-A and CLA procedures. The scopists and assistant surgeons in the LESS-A group did not suffer local pain or dullness (p = 0.793 and p = 0.240, respectively). They did, however, suffer more eyestrain than those in the CLA group (p = 0.001 and p = 0.001, respectively). Although LESS-A is generally considered to be a technically difficult procedure, the results of this study demonstrate that the feelings of physical fatigue are roughly equivalent between LESS-A and CLA procedures.

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.

Clinical Comparison of 5mm Mini-incision Laparoendoscopic Single-Site Hysterectomy and Traditional Laparoendoscopic Single-Site Hysterectomy

Objective: To investigate the feasibility of 5mm mini-•incision Laparoendoscopic Single-Site hysterectomy and Laparoendoscopic Single-Site hysterectomy in terms of safety, postoperative pain and cosmetic effect. Methods: The medical records of 19 patients who underwent hysterectomy with 5mm mini-•incision Laparoendoscopic Single-Site Surgery (LESS) or traditional Laparoendoscopic Single-Site Sugery in the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University from December 2017 to June 2020 were retrospectively analyzed, including 6 cases in the group of 5mm mini-•incision Laparoendoscopic Single-Site hysterectomy through umbilical ordinary incision (5mm) and 13 cases in the group of traditional Laparoendoscopic Single-Site hysterectomy through umbilical ordinary incision (1.5cm-3cm). Collect and compare the intraoperative blood loss, the operative time, the postoperative hemoglobin descender, the postoperative hospital stays, the probability of postoperative wound infection, the total cost, Visual analogue scale (VAS) of 12 hours after surgery, VAS of 24 hours after surgery and postoperative Body Image Questionnaire (BIQ, including Body Image scale, BIS and Cosmetic Score, CS) in the two groups. Results: There was no intraoperative complication happened, and there was no significant difference between the two groups in the forms of the intraoperative blood loss, operative time, postoperative hospital stays, postoperative hemoglobin descender, the probability of postoperative wound infection, the total cost, VAS of 24 hours after surgery and CS (P > 0.05). But the VAS of 12 hours after surgery of the 5mm mini-•incision Laparoendoscopic Single-Site hysterectomy was lower than traditional Laparoendoscopic Single-Site hysterectomy (1.17±0.14 vs. 2.33±0.19), the BIS of the former was higher than the later (19.83±0.15 vs 19.16±0.28), and importantly the difference was statistically significant (P < 0.05). Conclusion: Laparoendoscopic Single-Site through 5mm mini-incision is safe and feasible. Compared with traditional Laparoendoscopic Single-Site Hysterectomy through ordinary incision, it can not only significantly reduce postoperative pain, but also bring more satisfactory postoperative cosmetic effect.

Laparo-endoscopic single site hysterectomy in renal transplant women using conventional laparoscopic instruments

Laparo-endoscopic single site hysterectomy in renal transplant women using conventional laparoscopic instruments

Clinical cohort study of total hysterectomy via transvaginal natural orifice transluminal endoscopic surgery and transumbilical laparoendoscopic single site surgery

Objective: To study the safety and feasibility of total hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and transumbilical laparoendoscopic single site surgery (TU-LESS). Methods: The study was a retrospective cohort analysis. In West China Second University Hospital, from October 1, 2018 to June 30, 2019, the patients with an indication for hysterectomy due to benign uterine diseases were enrolled, and were grouped by the surgical procedure. Various post-operative surgical outcomes, including the success rate of operation, uterine volume, operative time, blood loss, intraoperative complications, postoperative complications, the first time of flatus, the preserved time of catheter after operation, and the length of hospitalization were measured. The data were assessed by the software of SPSS. Results: Totally 30 patients were included in the vNOTES group, and 77 patients were included in the TU-LESS group, all of the procedures were completed successfully without conversion to traditional multiport laparoscopy or laparotomy. Non differences were observed between two groups, including uterine volume [(165±36) vs (235±38) cm3, P=0.243], operation time [(150±41) vs (169±48) minutes, P=0.063], blood loss [(54±15) vs (54±14) ml, P=0.985], the rate of intraoperative complications [3% (1/30) vs 4% (2/77), P=1.000], the rate of postoperative complications [13% (4/30) vs 4% (3/77), P=0.095] and the rate of bilateral salpingo-oophorectomy [50% (15/30) vs 31% (24/77), P=0.069]. Patients in the vNOTES group had significantly less recovery time of intestine function [(1.7±0.5) vs (2.3±0.6) days, P=0.001], shorter time of indwelling catheter [(1.9±0.4) vs (2.3±0.6) days, P=0.004], and duration of hospitalization [(3.2±0.8) vs (3.6±0.9) days, P=0.045]. Conclusions: vNOTES and TU-LESS are both safe and feasible for total hysterectomy. Compared with TU-LESS, vNOTES may be a promising approach with earlier recovery, less injury and better cosmetic.

P.686 Eating behaviour and social cognition in obese adolescents

Laparoendoscopic single-site (LESS) surgery and minilaparoscopy (ML) represent the evolution of laparoscopy for the treatment of urologic diseases.To describe the technique and report the surgical outcomes of minilaparoendoscopic single-site dismembered pyeloplasty (MILESS-DP), a new technique overcoming the technical limitations of LESS and ML, and equally combining the advantages of both these surgical procedures.Twenty consecutive patients underwent MILESS-DP for ureteropelvic junction obstruction.The SILS port was inserted through a transumbilical incision and two 3-mm trocars were inserted in the ipsilateral midclavicular line. The sequence of steps of MILESS-DP is comparable to standard laparoscopic dismembered pyeloplasty.The end points of this study were: (1) feasibility; (2) safety; (3) efficacy; and (4) cosmesis, evaluated using a body image questionnaire.All patients were symptomatic (100%) and three (15%) had concomitant kidney stones. (1) Feasibility: a conversion to either standard laparoscopic technique or open technique did not occur in any case. Median operative time was 147.3 min (interquartile range [IQR]: 110–195 min); (2) safety: no intraoperative complications were reported. Only in two patients (10%), a urinoma was postoperatively identified and conservatively treated with an ureteral stent. The median difference in post- and preoperative creatinine and haemoglobin was +0.55 mg/dl and -0.76 mg/dl (IQR: -0.20/-1.20 mg/dl); (3) efficacy: the median postoperative hospital stay was 4.4 d (IQR: 4–9 d). The overall success rate was 95% at the follow-up; (4) cosmesis: all patients were enthusiastic with the appearance of the scars; the median body image score and the median cosmesis score were 19.95 (IQR 19–20) and 23.95 (IQR 23–24), respectively. The limitations of this study are the limited series and short follow-up.Our phase 2a studies demonstrate that MILESS-DP is a safe and reproducible procedure with excellent cosmetic outcomes and short-term clinical outcomes in the hands of a surgical team with experience in laparoscopy.Minilaparoscopy using 3-mm instruments and laparoendoscopic single-site using a single abdominal incision, still present several technical drawbacks which limit their reproducibility in urology. In order to overcome these technical limitations and equally combining the advantages of both these surgical procedures, we ideated a hybrid technique which we defined minilaparoendoscopic single-site. This study aims to demonstrate that minilaparoendoscopic single-site pyeloplasty is a safe and reproducible procedure with excellent cosmetic outcomes and short-term clinical outcomes in the hands of a surgical team with experience in mini-invasive surgery.

Preservation of Ovarian Reserve and Hemostasis during Ovarian Cystectomy: A Randomised Controlled Trial

Study Objective This study aims to evaluate the safety and efficacy of the hemostatic agent on ovarian reserve during laparoendoscopic single-site (LESS) ovarian cystectomy. Design Investigator-initiated, single-blinded, randomized controlled trial. Setting LESS ovarian cystectomy. Patients or Participants From December 2017 to February 2019, 52 patients with benign unilateral ovarian cysts were enrolled. Interventions We performed LESS unilateral ovarian cystectomies based on the same surgical protocol, minimizing bipolar coagulation. In the coagulation group, the patients received hemostasis using bipolar coagulation, whereas oxidized cellulose polymer was applied in the hemostatic agent group. Measurements and Main Results We compared the hemoglobin (Hb) and anti-Müllerian hormone (AMH) levels, and ovarian volumes just before surgery, and two days (2D-POST), one week (1W-POST), and three months after surgery (3M-POST), and the decline ratio. There were no differences in the Hb levels, AMH levels, or ovarian volumes. Moreover, there were no differences in the decline ratio of the Hb levels and ovarian volumes between the two groups, whereas the decline ratio of serum AMH levels was greater at 3M-POST in the coagulation than in the hemostatic agent group (median intention-to-treat [ITT], -36.7 vs. -13.3%; per-protocol [PP], -36.8 vs. -13.3%; P < 0.05). Notably, the difference of decline ratio of serum AMH levels was prominent in the coagulation than in the hemostatic agent groups when only patients with endometriosis were included in the analysis (median; ITT, -50.7 vs. -14.4%; PP, -50.7% vs. -14.4%; P < 0.05). There was no difference between the two groups when only patients with non-endometriosis were included in the analysis. Conclusion Oxidized cellulose polymer hemostatic agents may be non-inferior to bipolar coagulation for preserving ovarian reserve and hemostasis during LESS ovarian cystectomy. In particular, the hemostatic agent may be better for preserving ovarian reserve than bipolar coagulation in patients with ovarian endometriosis. This study aims to evaluate the safety and efficacy of the hemostatic agent on ovarian reserve during laparoendoscopic single-site (LESS) ovarian cystectomy. Investigator-initiated, single-blinded, randomized controlled trial. LESS ovarian cystectomy. From December 2017 to February 2019, 52 patients with benign unilateral ovarian cysts were enrolled. We performed LESS unilateral ovarian cystectomies based on the same surgical protocol, minimizing bipolar coagulation. In the coagulation group, the patients received hemostasis using bipolar coagulation, whereas oxidized cellulose polymer was applied in the hemostatic agent group. We compared the hemoglobin (Hb) and anti-Müllerian hormone (AMH) levels, and ovarian volumes just before surgery, and two days (2D-POST), one week (1W-POST), and three months after surgery (3M-POST), and the decline ratio. There were no differences in the Hb levels, AMH levels, or ovarian volumes. Moreover, there were no differences in the decline ratio of the Hb levels and ovarian volumes between the two groups, whereas the decline ratio of serum AMH levels was greater at 3M-POST in the coagulation than in the hemostatic agent group (median intention-to-treat [ITT], -36.7 vs. -13.3%; per-protocol [PP], -36.8 vs. -13.3%; P < 0.05). Notably, the difference of decline ratio of serum AMH levels was prominent in the coagulation than in the hemostatic agent groups when only patients with endometriosis were included in the analysis (median; ITT, -50.7 vs. -14.4%; PP, -50.7% vs. -14.4%; P < 0.05). There was no difference between the two groups when only patients with non-endometriosis were included in the analysis. Oxidized cellulose polymer hemostatic agents may be non-inferior to bipolar coagulation for preserving ovarian reserve and hemostasis during LESS ovarian cystectomy. In particular, the hemostatic agent may be better for preserving ovarian reserve than bipolar coagulation in patients with ovarian endometriosis.

A Beginners Guide to Laparoendoscopic Single-Site Surgery (LESS)

Study Objective To provide a basic introduction to Laparoendoscopic Single-Site surgery (LESS) for the gynecologist including basic set up, concepts, and tips. Design Video submission created. Setting The operating room set up and procedure was recorded. Patients or Participants One patient involved in all video demonstrated. Interventions Laparoendoscopic Single-Site (LESS) Surgery recorded. Measurements and Main Results Laparoendoscopic Single-Site (LESS) procedure was recorded. Conclusion After reviewing the video presented you will have basic instructions including tips and tricks to performing single-site surgery.

Transumbilical Laparoendoscopic Single-Site Radical Hysterectomy without Uterine Manipulator and with Vaginal Closure

Study Objective Minimally invasive surgery (MIS) of radical hysterectomy (RH) was reported with inferior oncologic outcomes according to the New England Journal of Medicine (NEJM). Then some studies suggested that the no-touch technique may be a useful procedure to prevent tumor spillage as well as improve survival, and the procedures were improved continuously. Therefore, we performed RH targeting early-stage cervical cancer through laparoendoscopic single-site (LESS) approach with enclosed colpotomy and without uterine manipulator. Design A presentation of the surgery through this technical video. Setting A Hospital. Patients or Participants A 48-year-old postmenopausal woman was diagnosed as cervical cancer with stage IB1(FIGO 2018). Interventions After fully informed of the benefits and risks of different surgical approaches (open laparotomy and MIS), she agreed with the MIS. Measurements and Main Results The type C radical hysterectomy via LESS approach was performed successfully, the final pathologic findings confirmed stage IB1 cervical carcinoma. The patient recovered fast and well with slight pain, and the incision scar was hidden perfectly for cosmetic purpose. Conclusion This video demonstrated that LESS-RH with vaginal closure and without manipulator was feasible and safe. Suspension skills played a significant role in the LESS-RH. Besides, this surgery procedure also involved 4 specific techniques to prevent tumor spillage, including creation of a vaginal cuff, avoidance of interoperate uterine manipulator, standard extent and bagging of the specimen. These adaptations were meant to minimize tumor manipulation and disruption, for reducing the increased risk of recurrence. However, further verifications were still required.

Laparoendoscopic Single-Site Surgery for Management of Tubo-Ovarian Abscess After Hymenectomy for Imperforate Hymen

Background: A tubo-ovarian abscess is a potential late complication after hymenectomy for imperforate hymen, especially when complicated with hematosalpinx. Laparoendoscopic single-site (LESS) surgery for management of tubo-ovarian abscess after hymenectomy has never been reported. Case: A 17-year-old virgin girl without a menarchal flow was referred due to a large pelvic cystic mass. With a diagnosis of an imperforate hymen with right hematosalpinx, an uneventful hymenectomy was performed for this patient. Six weeks later, she presented with lower-abdominal pain and febrile morbidity. Results: Antibiotics administration was initiated with the diagnosis of a right tubo-ovarian abscess. After failed medical management, LESS surgery was performed. Under laparoscopic observation, a severe pelvic adhesion around swollen right adnexal tissue was noted. After extensive adhesiolysis, a right salpingo-oophorectomy was performed, and the patient's postoperative course was uneventful. Conclusions: After hymenectomy for imperforate hymen with hematosalpinx, careful follow-up should be done to detect any secondary ascending pelvic infection leading to a tubo-ovarian abscess. LESS surgery may be a feasible minimally invasive option for managing a tubo-ovarian abscess with potential cosmetic benefits.

LAPAROENDOSCOPIC SINGLE-SITE SURGERY VERSUS CONVENTIONAL MULTI-PORT LAPAROSCOPY IN OVARIAN DRILLING: A RANDOMIZED CONTROLLED TRIAL

To compare the efficacy and safety of Laparoendoscopic single site surgery (LESS) to conventional multiport laparoscopy (CML) for laparoscopic ovarian drilling (LOD) in polycystic ovary syndrome patients (PCOS).