Single-site Laparoscopic Surgery Research Articles

Questionnaire to Survey Cosmetic Outcomes in Laparoscopic Surgery for Colorectal Cancer

Background and objectives: There has been a steady increase in the use of minimally invasive surgery, including conventional multiport laparoscopic surgery (MLS) and single-site laparoscopic surgery (SLS) for colorectal cancer. We aimed to evaluate how important the cosmetic outcome, one of the advantages of SLS, is to patients and whether SLS reflects social needs. Methods: We used a web-based questionnaire to survey nonmedical and medical workers for what factors were considered on the assumption that respondents undergo colorectal cancer surgery and that the most important person for them undergoes. Five items (curability, safety, pain, length of hospital stay, and cosmetic outcomes) were compared. After paired photographs before and after SLS and MLS were shown, perceptions of body image and cosmesis were assessed using a visual analog scale. Results: This study included a total of 1352 respondents (990 nonmedical and 362 medical). Curability had the highest score (49.9–53.7 points), followed by safety (23.8–24.7 points). The scores for cosmetic outcomes (6.2–7.1 points) were almost equal to those of the length of hospital stay (6.2–7.1 points), which was associated with medical costs and pain (10.0–11.1 points), one of the main reasons for fear of surgery. Participants who were female, younger, and in the nonmedical group placed great importance on cosmetic outcomes. For all questions regarding body image and cosmesis, SLS had superior scores compared with MLS. Conclusions: Understandably, curability, and safety were most important in colorectal cancer surgery. However, medical workers should consider cosmetic outcomes, even in malignant cases.

Questionnaire to Survey Cosmetic Outcomes in Laparoscopic Surgery for Colorectal Cancer

Background and objectives: There has been a steady increase in the use of minimally invasive surgery, including conventional multiport laparoscopic surgery (MLS) and single-site laparoscopic surgery (SLS) for colorectal cancer. We aimed to evaluate how important the cosmetic outcome, one of the advantages of SLS, is to patients and whether SLS reflects social needs. Methods: We used a web-based questionnaire to survey nonmedical and medical workers for what factors were considered on the assumption that respondents undergo colorectal cancer surgery and that the most important person for them undergoes. Five items (curability, safety, pain, length of hospital stay, and cosmetic outcomes) were compared. After paired photographs before and after SLS and MLS were shown, perceptions of body image and cosmesis were assessed using a visual analog scale. Results: This study included a total of 1352 respondents (990 nonmedical and 362 medical). Curability had the highest score (49.9–53.7 points), followed by safety (23.8–24.7 points). The scores for cosmetic outcomes (6.2–7.1 points) were almost equal to those of the length of hospital stay (6.2–7.1 points), which was associated with medical costs and pain (10.0–11.1 points), one of the main reasons for fear of surgery. Participants who were female, younger, and in the nonmedical group placed great importance on cosmetic outcomes. For all questions regarding body image and cosmesis, SLS had superior scores compared with MLS. Conclusions: Understandably, curability, and safety were most important in colorectal cancer surgery. However, medical workers should consider cosmetic outcomes, even in malignant cases.

A trans-umbilical single-site plus one robotic-assisted surgery for choledochal cyst resection in children.

The purpose of this study is to compare the intraoperative and postoperative outcomes of a trans-umbilical single-site plus one robot-assisted surgery and a trans-umbilical single-site laparoscopic surgery in the treatment of choledochal cysts. We retrospectively analyzed clinical data from 49 children diagnosed with choledochal cysts who were admitted to our hospital between June 2020 and December 2023. Among these patients, 24 underwent a trans-umbilical single-site plus one Da Vinci robot-assisted surgery (the robot group) and 25 underwent a trans-umbilical single-site laparoscopic-assisted surgery (the laparoscopic group). We compared differences in intraoperative and postoperative outcomes between the two groups. There was no significant difference between the two groups of patients in terms of gender, age, weight, clinical symptoms, maximum cyst diameter, type, postoperative complications, and facial expression, leg movement, activity, crying, and comfortability (FLACC) scoring (p > 0.05). Compared with the patients in the laparoscopic group, those in the robot group had less intraoperative bleeding [10 (8-12) vs. 15 (11.5-18) ml, p < 0.001] and required less postoperative drainage tube indwelling time [5 (4-6) vs. 7 (5.5-8) day, p < 0.001], less postoperative fasting time [4 (3-4) vs. 6 (5-7) days, p < 0.001], and less postoperative hospitalization time [6 (6-7) vs. 8 (6-10) days, p < 0.001], but they required more operative time [385.5 (317.0-413.3) vs. 346.0 (287.0-376.5) min, p = 0.050] and consumed more hospitalization expenses (79,323 ± 3,124 vs. 31,121 ± 2,918 yuan, p < 0.001). The results of this study showed a shorter hospitalization time, quicker postoperative recovery, and less tissue damage but a higher cost and a longer operation time in patients who chose robotic surgery rather than laparoscopic surgery. With the continuous expansion of the scale of installed robot-assisted surgical systems and the gradual accumulation of the technical experience of surgeons, robot-assisted surgery may slowly surpass, and shows a trend to replace, laparoscopy because of its advantages.

Retracted: Hysterectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery versus Transumbilical Laparoscopic Single-Site Surgery: A Single-Center Experience from East China.

[This retracts the article DOI: 10.1155/2022/8246761.].

Comparative study of supracervical hysterectomy between da Vinci SP® surgical system and conventional single-site laparoscopy for uterine fibroid: single center experiences

This study aimed to review the surgical outcomes of supracervical hysterectomy using the da Vinci SP® surgical system and conventional single-site laparoscopic surgery for uterine fibroids. This study included 79 patients who underwent supracervical hysterectomy with the da Vinci SP® surgical system and conventional single-site laparoscopy for uterine fibroid between June 2018 and April 2021. All the surgeries were performed by an experienced surgeon. Surgical outcomes and complications were reviewed in both groups. No significant difference was found between the two groups with regards to the patients’ preoperative surgical conditions such as weight of the uterus, history of pelvic surgery, and pelvic adhesion. A significantly longer operation time (p < 0.01) and higher levels of C-reactive protein (p < 0.01) were found in the robotic surgery group; in particular, the uterus-out time was significantly longer (p < 0.01). No significant differences were found in other surgical outcomes such as complication rates and hospital stays. Supracervical hysterectomy using the da Vinci® SP surgical system is comparable to conventional single-site laparoscopy in uncomplicated cases. However, it requires a significantly longer operative time and has a higher inflammatory response.

8653 Technique for Cosmetic Closure of the Umbilicus during Single Site Laparoscopy

<h3>Study Objective</h3> This presentation demonstrates a novel technique to ensure cosmetic closure of the umbilicus during single-site laparoscopy. Single-site laparoscopy has grown in popularity as it leaves a single abdominal scar that can be hidden within the umbilicus. However, usual closure technique is often not sufficient to optimize the appearance for patients. <h3>Design</h3> Instructional Video. <h3>Setting</h3> Tertiary care center outside of a major city in the United States. <h3>Patients or Participants</h3> Patients presenting for single-site laparoscopic gynecologic surgery. <h3>Interventions</h3> Abdominal entry is performed using Hassan technique through a single vertical skin incision extending just superior and inferior to the umbilical edges. After the procedure is complete, the fascia is closed with a single running 0 polyglactin suture. The skin is undermined to create bilateral flaps and redundant tissue is trimmed. The fascia is grasped by a Kocher clamp and two throws of a 2-0 polyglactin suture on a non-cutting needle are driven through one skin edge, through the fascia and through the opposite skin edge to recreate the umbilical base. The sutures are tied down in sequence, and the remaining skin is reapproximated with several interrupted, inverted 3-0 polyglactin sutures on a cutting needle. Using this method, the final incision is under 3 centimeters and the natural depth of the umbilicus is recreated. The incision is cleaned and dressed with petroleum gauze, an eye patch, and an occlusive dressing with excess air removed with an empty syringe. <h3>Measurements and Main Results</h3> At 6 weeks after surgery the incision is hardly visible, and the reconstructed umbilicus resembles its natural pre-operative appearance. <h3>Conclusion</h3> When single-site laparoscopy is performed, cosmesis can be optimized by using a specialized technique to reconstruct the umbilicus.

7490 Perioperative Outcomes of the "Chopsticks Technique" Single-Site Laparoscopy Versus Traditional Laparoscopy for Endometrial Cancer

<h3>Study Objective</h3> To describe the new "chopsticks technique" single-site laparoscopic surgery technology and to compare the perioperative outcomes of the new "chopsticks technique" laparoendoscopic single-site surgery (LESS) versus traditional laparoscopic surgery (TLS) in the staging surgery of endometrial cancer (EC). <h3>Design</h3> Retrospective case-control study based on propensity score matching (PSM). <h3>Setting</h3> Department of gynecology at a tertiary medical center. <h3>Patients or Participants</h3> From August 2018 to August 2020 at Southwest Hospital in Chongqing, China, patients diagnosed with endometrial cancer, a total of 26 cases conducted LESS were matched with a cohort of 52 cases who underwent TLS. <h3>Interventions</h3> A propensity score matching was performed to reduce the bias due to the imbalanced baseline features between the two groups, and the perioperative outcomes were compared between matched cohorts. <h3>Measurements and Main Results</h3> We retrospectively reviewed 535 cases of patients diagnosed with endometrial cancer from our institutional database. A 1:2 propensity score matching was conducted matched by age, BMI, history of surgery, FIGO staging between the two groups. After matching, the variables were well balanced with no differences at baseline between groups. The operations in both groups were successfully completed without conversion to laparotomy. There were no statistically significant differences in the amount of intraoperative blood loss, number of lymph nodes removed, postoperative exhaust time, postoperative indwelling drainage time, postoperative hospital stay, etc. between the two groups (P>0.05). Meanwhile, compared with the TLS group, the LESS group has longer operation time, a lower pain score of 24-hour after surgery and a more satisfactory postoperative cosmetic effect, of which the difference was statistically significant (P <0.05). <h3>Conclusion</h3> It is undoubtedly safe and feasible for staging endometrial cancer to employ the "chopsticks technique" single-site laparoendoscopic with minimum scars from abdominal incisions, which results less pain and outstanding cosmetic effects. However, further prospective, randomized studies with larger samples are needed.

Hysterectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery versus Transumbilical Laparoscopic Single-Site Surgery: A Single-Center Experience from East China.

Objective To compare hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (VNOTES) versus transumbilical laparoscopic single-site surgery (LESS) as a minimal invasive technique. Materials and Method. The women undergoing hysterectomy for benign diseases by VNOTES and LESS from January 2020 to June 2021 in a tertiary hospital in Shanghai were retrospectively analyzed. Results 361 women were included in our study, with 228 in the VNOTES groups, 129 in the LESS groups, and 4 conversions from VNOTES to LESS technique. The length of a VNOTES hysterectomy was shorter than that of LESS (80.76 min versus 112.09 min; MD -31.34 min; 95% CI -40.24 to -22.43 min; P < 0.001). VNOTES hysterectomy has a quicker gas passage by the anus (18.80 versus 36.49 hours, MD -17.68 hours, 95% CI -20.23 to -15.14 hours, P < 0.001) and associated with a shorter length of hospital stay (2.31 versus 3.77 days, MD -1.46 days, 95% CI -1.75 to -1.17 days, P < 0.001), while with no increase in blood loss during the operation (median 50 versus 50 ml, P = 0.25). Besides, the VAS pain score in the 24th hour after the operation was lower (median 0 versus 0.5, P < 0.001) in the VNOTES group. Four unique phases of the learning curve were identified using cumulative analysis: the mean operation time of phase I was 82.81 ± 31.45 min (the initial learning curve of 43 cases), phase II was 72.48 ± 23.66 min (the acquisition of command of 91 cases), phase III was 103.77 ± 45.69 min (the further learning of 26 cases), and phase IV was 73.18 ± 26.89 min (postlearning in 68 cases). Conclusions VNOTES is noninferior to LESS as a new minimal invasive procedure for hysterectomy, which also allows patients a faster recovery from surgery and to suffer less pain, and its efficiency and feasibility in large uterine need further exploring.

Critical Steps to Performing a Successful Single-site Laparoscopic Myomectomy for Large Pedunculated Myoma during Pregnancy

To demonstrate tips and tricks for the successful use of single-site laparoscopic surgery for pedunculated myomectomy during pregnancy. Stepwise demonstration with narrated video footage. An academic tertiary care hospital affiliated with Baylor College of Medicine. Our patient is a 39-year-old pregnant G1P0010 with a symptomatic 12-cm degenerating pedunculated myoma refractory to conservative pain management. Recent literature has indicated that most laparotomic myomectomies performed during pregnancy showed overall positive pregnancy outcomes and low complications. This indicates that myomectomy in pregnancy is safe and can be used in cases unresponsive to conservative management [1]. However, cases in literature discussing the single-site techniques for laparoscopic myomectomy during pregnancy have been sparse [2]. Four case series were reviewed; a total of 62 pregnant patients underwent laparoendoscopic single-site surgery without any complications [3-6]. Using laparoscopy in myomectomy compared with laparotomy during pregnancy permits decreased postoperative pain, quicker recovery, and lowered risk of postoperative complications [5,7,8]. Single-site laparoscopic surgery also aids in improved patient cosmesis and can be used for the myoma removal. Literature has demonstrated that single-site laparoscopy is safe and feasible during all stages of pregnancy [3,4]. Nevertheless, this approach may be challenging for inexperienced surgeons owing to the lack of triangulation and crowding of instruments in single-site laparoscopy [5]. At 21 weeks and 3 days pregnancy, our patient underwent single-incision laparoscopic surgery myomectomy. A 2.5-cm skin incision was made at the umbilicus to the abdominal cavity, and a GelPOINT Mini was inserted. Through the laparoscope, we can observe that a 12-cm pedunculated myoma was protruding from the right uterine fundus on a 4-cm stalk. A 0-Vicryl suture was tied around the base of the stalk. The stalk was then cauterized with bipolar energy and transected with the harmonic scalpel, completely detaching the myoma. Subsequently, an Endo Catch bag was placed around the myoma and brought up to the umbilical incision. Using a scalpel, bag-contained morcellation was completed within 22 minutes and the contents removed. As a result, the estimated blood loss was 50 cc and the total operative time was 123 minutes. The extended operating time was caused by slow movements to avoid disrupting the fetus. She had an unremarkable postoperative course, no medications were needed for pain management, and she was discharged home on postoperative day 2. At 38 weeks, she successfully delivered with elective cesarean delivery with no complications. Histopathology showed fragments of leiomyoma with diffuse necrosis. Tips and tricks: 1. Single-site entry technique uses the open Hasson technique, which reduces the risk of injury to the pregnant uterus and dilated surrounding vessels. 2. Through a 2.5-cm incision, the surgeon placed a suture in the myoma stalk because other hemostasis agents such as vasopressin are contraindicated in pregnancy. 3. Owing to difficulties related to single-site surgery, the surgeon should possess extensive expertise in single-site surgery. 4. Manipulation of the uterus should be minimized to reduce the disturbance of the pregnant uterus. 5. V-loc suture allows for faster and simplified uterine incision closure. 6. If the surgeon encounters excessive difficulty during the surgery, a 5-mm accessory port can be placed. 7. During tissue extraction, gentle traction should be used to reduce provoking the pregnant uterus. 8. When transecting the myoma stalk, it is important to leave a stump of more than 1 cm to increase suturing ease and prevent accidental suturing of the uterus. Single-incision laparoscopic surgery myomectomy for pedunculated myoma may be a practical technique in women refractive to conservative management. When performed by an experienced surgeon, the patient may benefit from faster specimen removal and recovery.

Evaluation of the learning curve and safety outcomes in robotic assisted vaginal natural orifice transluminal endoscopic hysterectomy: A case series of 84 patients.

To explore the learning curve and safety outcomes of robotic assisted transvaginal natural orifice transluminal endoscopic surgery (R-vNOTES) for hysterectomy in benign gynaecological diseases. A retrospective chart review of all patients undergoing R-vNOTES hysterectomy for benign gynaecological disease from 2019 to 2021. An academic tertiary care university hospital in Houston, TX, USA. 84 patients were identified that met the study requirements. The mean hysterectomy time was 77.27±2.89min. The median additional operation time was 63 (8-206)min. There were two conversions to robotic assisted single incision laparoscopy. Thirteen (15.48%) patients had an associated complication. Analysis of the learning curve suggests plateauing of hysterectomy time at approximately 10 cases and time for robot docking and port placement after 10-20 cases. R-vNOTES is a safe and effective route for hysterectomy. For a surgeon with experience in laparoscopic single site surgery and abdominal robotic surgery, they need to perform 10 cases of R-vNOTES hysterectomy and 10-20 cases in port placement and robotic docking to achieve proficiency.

Perioperative Outcomes of the New Chopsticks Technique Single-Site Versus Traditional Laparoscopy in the Staging of Endometrial Cancer

<h3>Study Objective</h3> To describe the new"chopsticks technique"single-site laparoscopic surgery technique, and compare the Perioperative outcomes of "chopsticks technique" single-site laparoscopy versus traditional laparoscopy for endometrial cancer. <h3>Design</h3> A retrospective case-control study based on propensity score matching. <h3>Setting</h3> Department of gynecology at a tertiary medical center. <h3>Patients or Participants</h3> From August 2018 to August 2020, a total of 78 patients who accepted the laparoscopic staging of endometrial cancer were retrospectively analyzed. 26 cases conducted "chopsticks technique"single-site laparoscopic surgery(LESS) were matched with a cohort of 52 cases who underwent traditional multi-site laparoscopic surgery (CLS). <h3>Interventions</h3> A propensity score matching was performed to reduce the bias due to the imbalanced baseline features between the two groups and the perioperative outcomes were compared between matched cohorts. <h3>Measurements and Main Results</h3> A retrospective case–control study was conducted matched by age, BMI, history of surgery, FIGO staging. After matching, the variables were well balanced with no differences at baseline between groups. The operations in both groups were successfully completed without conversion to laparotomy. There were no statistically significant differences in the amount of intraoperative blood loss, pelvic lymph nodes, number of para-aortic lymph nodes removed, postoperative exhaust time, postoperative indwelling drainage time, postoperative hospital stay between the two groups (P>0.05). Meanwhile, Compared with the traditional multi-port laparoscopic group CLS, the "chopsticks technique" single-site laparoscopic group (LESS) has longer operation time (197.3±55.7 vs. 164.7±62.7, p=0.043) , a pain score of 24-hour after surgery (3 (3,2) vs3 (4,2) , p=0.031) and a more satisfactory postoperative cosmetic effect (6.9±0.5 vs. 6.12±0.7, p=0.023) , of which the difference was statistically significant (P <0.05). <h3>Conclusion</h3> It is safe and feasible for staging endometrial cancer to employ the"chopsticks technique"single-site laparoscopic with minimum scars from abdominal incisions, which results in less pain and outstanding cosmetic effects. However, further prospective, randomized studies with larger samples are needed.

Contained Tissue Extraction of a Presumed Benign Large Ovarian Tumor within an Inflated Containment System

<h3>Study Objective</h3> Demonstrate contained tissue extraction technique of a large presumed benign ovarian mass. <h3>Design</h3> Surgical video. <h3>Setting</h3> Outpatient laparoscopic single site surgery. <h3>Patients or Participants</h3> Single surgical case of a 41-year-old with a large dermoid tumor of the right ovary. <h3>Interventions</h3> Total laparoscopic hysterectomy and salpingoophorectomy. Video obtained of the salpingoophorectomy with containment and extraction technique. <h3>Measurements and Main Results</h3> Containment and extraction of a large dermoid tumor. <h3>Conclusion</h3> Contained tissue extraction within an inflated bag is useful for large presumed benign ovarian masses.

Resection of a Cornual Heterotopic Pregnancy Using Single-Site Laparoscopic Techniques

<h3>Study Objective</h3> To describe techniques for resection of a cornual heterotopic pregnancy. <h3>Design</h3> Demonstration of surgical technique with narrative video footage using two case examples. <h3>Setting</h3> Academic medical center. <h3>Patients or Participants</h3> A case of an 8-week cornual heterotopic pregnancy with successful delivery of the intrauterine pregnancy and a case of a cornual ectopic at 10 weeks. <h3>Interventions</h3> We demonstrate the use of a "purse string" technique using robotic assisted single incision laparoscopy to resect a cornual heterotopic with minimal blood loss using a 2-0 V-lock suture. Additionally, we review this similar technique with traditional single-site laparoscopic surgery. <h3>Measurements and Main Results</h3> Resection of a cornual heterotopic pregnancy can be successful done using a "purse string" technique. This technique allows for minimal blood loss as well as minimal entry into the myometrium, which allows for minimal manipulation of the concurrent intrauterine pregnancy. <h3>Conclusion</h3> Resection of cornual heterotopic pregnancy can be done using a "purse-string" surgical technique. This technique allows for minimal blood loss in cases where additional techniques for hemostasis cannot be used, such as injection of vasopressin and uterine artery ligation. We also demonstrate that this technique can be successful completed using either traditional or robotic assisted single incision laparoscopic surgery.

Comparison of Weighted and Unweighted Task Load Indices for Single-Site Surgery Tasks

Background: The National Aeronautics and Space Administration Task Load Index (NASA-TLX) a nd Surgery Task Load Index (SURG-TLX) are two subjective workload m easurement instruments. Both instruments provide unweighted andweightedworkload measurements. Weighted TLX m easures have seldomly been used byresearchers typically becauseof its high correlation with unweighted TLX a nd addedexperimentaltime to collect pairwise weightings. Therefore, theaim of thestudy wa s to compare weighted TLX scores with unweighted TLX scores and each’s sensitivity for demographic and experimentalfactors. Methods: Two simulated la paroscopic single site surgery tasks were completedusing four surgicalmethods by 25 participants. Pearson correlations, principle componentanalyses and mixed effect models were used to compare the unweightedandweighted TLXscores across tasks a nd methods. Results: There was a high correlation(r &gt; 0.950, p &lt; 0.001) betweentheunweighted TLXscores and the weighted TLX scores. The weighted TLX scores showed better sensitivity to both demographic and experimental factors for both TLX instruments. Conclusion: The overall weighted NASA-TLX and SURG-TLX scores differed from their respective unweighted scores even with a high correlation. The weighted TLXshowed potentialto better discriminate subjective workloadfor single-site ta sks. Future research is needed to identify and validatea more streamlinedweightingmethodparticularly for complex experimental taskslike single-site surgery.

Laparoscopic single site surgery hysterectomy and bilateral salpingectomy for a patient with abnormal uterine bleeding-adenomyosis: a case report and review of the literature

Laparoscopic single site surgery hysterectomy and bilateral salpingectomy for a patient with abnormal uterine bleeding-adenomyosis: a case report and review of the literature

Comparison of conventional versus single port laparoscopy for surgical treatment of gynecological diseases: a pilot study.

IntroductionMany recent studies have conducted laparoscopic single-site surgery (LESS) using single-port laparoscopy (SPL), which combines conventional laparoscopy (CL) with a novel multichannel port. However, to implement SPL, several obstacles must be overcome.AimTo study the clinical value of SPL in the surgical treatment of gynecological diseases.Material and methodsTwenty-five patients with ectopic pregnancy (EP) and 11 with uterine leiomyoma (UL) were randomly assigned to undergo either LESS by SPL or CL. The CL was performed routinely, while the SPL was performed through a single port using a self-made, multi-channel laparoscopic approach based on CL. The following parameters were compared between the SPL and CL groups: intraoperative conditions (operation time and blood loss), postoperative conditions (exhaustion and hospital stay time), and visual analog scale. Patients with EP and those with UL were analyzed separately in this regard. In patients with UL, hemoglobin changes, complications, and long-term physical recovery within 6 months of surgery were also compared.ResultsThe operation time was significantly longer in the SPL group than in the CL group (p < 0.001). However, blood loss, postoperative exhaustion, and hospital stay time were significantly lower (p < 0.05 in all cases). In patients with UL, intraoperative and postoperative conditions did not differ significantly between the groups. At the follow-up within 6 months, patients with UL in the SPL group had recovered, with better cosmetic effects and more satisfaction. No cases of umbilical incisional hernia occurred in the SPL group.ConclusionsSPL showed clinical efficacy, with minimal invasion, rapid recovery, and cost-effectiveness in patients with EP or UL.

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.

Comparison of Transvaginal and Transumbilical Laparoscopic Single-Site Surgery for Ovarian Cysts

Background:Minimally invasive surgery is currently a preferred treatment for symptomatic ovarian cyst(s), with single-site techniques, such as transumbilical laparoendoscopic single-site surgery (TU-LESS) and transvaginal laparoendoscopic single-site surgery (TV-LESS), gaining increasing popularity. Although both methods have delivered positive outcomes, there is currently limited literature directly comparing TU-LESS and TV-LESS.Objectives:This study had two primary objectives: (1) to evaluate the safety and feasibility of TV-LESS and TU-LESS for the treatment of ovarian cysts and (2) to compare the surgical and postoperative outcomes of the two procedures.Method:This was a prospective observational clinical analysis of 81 patients with a diagnosis of benign ovarian cyst with indication for TV-LESS or TU-LESS. Surgeries were performed at a tertiary hospital between February 1, 2018 and January 31, 2020. Patients were divided into TV-LESS (n = 40) and TU-LESS groups (n = 40), with one excluded due to severe pelvic adhesive disease. Demographics, operation outcomes, and follow-up details were compared.Results:All 80 patients underwent uncomplicated procedures. The two groups were demographically matched (except age), with no difference in operation time, intra-operative blood loss, hemoglobin loss, and hospitalization costs (P > 0.05). However, TV-LESS patients had significantly faster time to ambulation (P < 0.001), faster time to return of bowel function (P < 0.001), less postoperative pain level (P < 0.001), and shorter length of hospital stay (P < 0.001). The cosmetic scores at 1, 4, and 24 weeks after surgery were also higher for the TV-LESS group.Conclusion:Our preliminary experience suggested that TU-LESS and TV-LESS are both feasible and safe for ovarian cystectomy and salpingo-oophorectomy. However, TV-LESS may provide three main advantages including: (1) fewer postoperative complications (i.e. incisional hernia); (2) less postoperative pain; and (3) improved cosmetic satisfaction.

Therapeutic difficulties in vesicorectal fistula treatment using several techniques in one center

Introduction: Vesicorectal fistula (VRF) is a rare but devastating condition that may develop after surgery or radiotherapy. Many surgical methods to treat VRF have been described, but there is still no gold standard of VRF treatment. Aim: The aim of the study is to present our experience in the treatment of VRFs and analyze different surgical techniques applied in our center retrospectively. Material and methods: From June 2016 to June 2020, 7 patients (5 males and 2 females) aged 59–73 years (average 67.3 years) were treated for VRF in our center. The primary causes of VRFs were complications after laparoscopic radical prostatectomy (LRP), sigmoidectomy, laparotomy with removal of the tumour of the vaginal stump and anterior rectal resection and colostomy, Hartmann’s operation due to rectosigmoid carcinoma, radiotherapy, treatment of cervical cancer and transurethral resection of bladder tumor (TURBT). The patients were treated with one of the following methods: transvesical laparoscopic single-site surgery (T-LESS), transanal minimally invasive surgery (TAMIS), transurethral fulguration and radical cystectomy with the Bricker’s ileal conduit. Results and discussion: Five patients underwent T-LESS, 2 TAMIS, 1 transurethral fulguration and 1 radical cystectomy with the Bricker’s ileal conduit. The mean postoperative hospital stay was 4 days (range 2–8 days). The mean operative time was 139 minutes (range 100–285 minutes). Only 1 patient had a recurrence of a fistula. Conclusions: Surgical management of VRFs is obligatory to prevent possible complications. Currently, there is no gold standard for treatment of VRFs. Therefore, this condition requires further investigation.

Robot-assisted Transvaginal Single-site Sacrocolpopexy for Pelvic Organ Prolapse

To demonstrate stepwise techniques for the successful use of the laparoscopic single-site technique for safely performing transvaginal sacrocolpopexy for pelvic organ prolapse. Stepwise demonstration with narrated video footage (Canadian Task Force classification III). Academic tertiary care hospital. The patient, aged 69 years gravida 2 para 2-0-0-2 with a history of SVD × 2, presented with symptomatic stage II anterior vaginal prolapse (Aa +1) and stage II posterior vaginal prolapse (Ap -1). The preoperative vaginal length was measured at 9 cm. Laparoscopic transvaginal single-site sacrocolpopexy has been demonstrated to be feasible and safe in the surgical management of pelvic organ prolapse. However, the retroperitoneal dissection or suturing/knot tying can be technically challenging to perform, especially in the event of an anatomic variation of a deeply angled S1 vertebra. Wristed robotic instrumentation may overcome some of these obstacles and result in easier suturing and knot tying. Integration of a robotic platform for sacrocolpopexy is a novel alternative minimally invasive approach that is more cosmetic, safer, and effective. Several helpful techniques in robot-assisted transvaginal single-site include the following: (1)The use of a 30°-angled scope alternating between "facing up" and "facing down" depending on the need for dissection or suturing. (2) The use of 3-dimensional visualization with a robotic camera that can highlight the depth of the surgical anatomy, therefore facilitating easier identification in the dissection of a surgical pedicle. (3) The use of wristed instruments that permit increased articulation and triangulation that are lacking in traditional laparoscopic single-site surgery, allowing for much easier and proficient suturing and knot tying. (4) Integration of the robotic platform that stabilizes the fine motor movement in a surgeon's hands improving the precision of the suturing and knot tying. The procedure was successfully performed in approximately 227 minutes with a measured postoperative vaginal length of 7 cm. The patient's postoperative pelvic organ prolapse quantification was stage 0. Robot-assisted transvaginal single-site sacrocolpopexy for pelvic organ prolapse is feasible, effective, and safe in patients with pelvic organ prolapse. Patients experience improved cosmesis, decreased postoperative pain, and faster recovery compared with abdominal sacrocolpopexy.