Multiport Laparoscopic Hysterectomy Research Articles

A Retrospective Study Comparing Operative Time Between Single-Glove Port Laparoscopic Hysterectomy and Conventional Multiport Laparoscopic Hysterectomy for Benign Gynecology Diseases: Hospital-Based Study in Thailand

Background: Laparoscopic hysterectomy is popular today. Using a 3- to 4-port for laparoscopic hysterectomy. But laparoscopic hysterectomy can be done by using a single-modified glove port. It was found to have good performance and low price. Objective: To compare operative time and other surgical outcomes between single-glove port laparoscopic hysterectomy (SGPLH) and conventional multiport laparoscopic hysterectomy (MPLH). Methods: A retrospective study, data were extracted from medical records of patients diagnosed with benign gynecologic diseases and underwent laparoscopic hysterectomy at Prapokklao Hospital, Chanthaburi, Thailand from February 2016 to April 2021. Results: A total of 125 patients were divided into 2 groups 65 (52%) in the SGPLH group and 60 (48%) in the MPLH group. The operative time of SGPLH was significantly shorter than conventional MPLH (mean [SD], 96 [31.35] vs 161.4 [57.37] minutes; P < .001). There was significant difference between 2 groups in terms of previous abdominal surgery (P = .01). In multivariate regression analysis, independent factors correlated with operative time were type of laparoscopic operation (P < .001), additional procedure of bilateral salpingo-oophorectomy (P = .02), unilateral salpingo-oophorectomy (P = .01), and complication with bladder injury (P = .03). Conclusions: The operative time of SGPLH is shorter than the conventional MPLH. SGPLH is also feasible and economical for patients with symptomatic benign gynecologic diseases.

Comparison of laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopic (CMPL) surgery for hysterectomy: long-term outcomes of abdominal incisional scar

There is scarcity of data about the long-term results such as port-site hernia, body image scale and cosmesis scale outcomes between laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopy (CMPL) for hysterectomy. Eighty women, who underwent total hysterectomy by the LESS (n = 40) and CMPL (n = 40) technique due to benign and malign gynecological disorders, were evaluated with a cosmesis and body image questionnaire in an age-matched cohort study.Median follow-up time was 25 (6–30) months in both groups. The mean age of the patients was 49.3 ± 6.3 years. The mean body image scale scores were 5.3 ± 0.6 and 5.5 ± 1.2 in the LESS and CMPL groups, respectively (p = 0.268). The mean cosmesis and scar scale scores were significantly higher in the LESS group compared to the CMPL group (p = .011 and p < .001, respectively). Port-site hernia was detected in two patients in the LESS group, but not in the CMPL group. There was no cuff dehiscence in the LESS nor in the CMPL group. The LESS technique provides better cosmesis when compared with the CMPL technique. The body image perceptions in the two groups were similar. Women who wish to undergo the LESS surgery should be informed about the risk of incisional hernia.Impact statementWhat is already known on this subject? Short-term results of LESS hysterectomy such as complication rates, additional port requirement, conversion to CMPL or laparotomy, pain score and analgesic use were evaluated in various studies. Several studies have been published on the safety and efficacy of single-port laparoscopic hysterectomy (LH); however, it has been unclear whether single-port LH offers benefits over multiport LH regarding long-term patient satisfaction and cosmetic satisfaction.What do the results of this study add? In this prospective cohort study, we aimed to compare long-term results (at least six months) of abdominal incisional scar between LESS and CMPL surgery for hysterectomy. The LESS technique provides better cosmesis when compared with the CMPL technique, although, the body image perceptions in the two groups were similar.What are the implications of these findings for clinical practice and/or further research? LESS technique can be offered as an option for hysterectomy since it provides better long-term cosmesis compared to CMPL.

Single-incision laparoscopic hysterectomy using conventional laparoscopic instruments: initial experience with 25 cases.

To evaluate the feasibility and safety of single-incision laparoscopic hysterectomy using conventional instruments. Twenty-five patients undergoing single-incision laparoscopic hysterectomy (SI-LAH) using conventional instruments at West China Second University Hospital between July, 2017 and December, 2017 were selected for participation. Another 25 cases undergoing traditional multi-port laparoscopic hysterectomy (MP-LAH) matched with similar uterine size were selected as controls. Characteristics and clinical data of patients including operative time, estimated blood loss, hospital stay, catheter retention time, and intraoperative and postoperative complications were compared between the two groups. The baseline characteristics of the two groups were comparable. The estimated blood loss was less in SI-LAH with respect to MP-LAH (30mL [range 20-50] vs 50mL [range 10-200], P < 0.05), with no statistically significant difference in terms of decrease of hemoglobin level (17g/dL [range 2-24] vs 18g/dL [range 5-28], P > 0.05). There were no significant differences between the two groups in terms of operative time (150min [range 85-225] vs 145min [range 100-220], P > 0.05), intraoperative injury, catheter retention time, time to exhausting, postoperative hospital stay. In all cases, no additional port incision was needed and no conversion to laparotomy was necessary in two groups. No patient had development of intraoperative or postoperative complications. After a follow-up of 2 months, no incisional hernia occurred in all patients. Single-incision laparoscopic hysterectomy using conventional instruments is a feasible and safe technique for patients with uterine size less than 12weeks of pregnancy and no serious pelvic adhesion, requiring for more experienced skill of surgeons.

Single-Port vs Multiport Laparoscopic Hysterectomy: A Meta-Analysis of Randomized Controlled Trials

Numerous studies have compared the surgical outcomes of single-port laparoscopic hysterectomy (LH) and conventional multiport LH, but the results are conflicting. The aim of this meta-analysis was to compare the safety and efficacy of single-port LH and multiport LH for benign gynecologic conditions based on published reports. PubMed, the Cochrane Central Register of Controlled Trials, and Embase were searched for relevant randomized controlled trials (RCTs). Outcome measures included intraoperative and postoperative complication rates, postoperative pain, conversion rate, operative time, estimated blood loss (EBL), and length of hospital stay. Pooled outcome measures (risk ratio [RR] and weighted mean difference [WMD]) were pooled with either a fixed-effects model or a random-effects model. Six RCTs encompassing 624 patients were included. There were no significant differences between single-port LH and multiport LH in terms of intraoperative complication rate (RR, 1.00; 95% confidence interval [CI], 0.14–7.05; p = .00), postoperative complication rate (RR, 0.95; 95% CI, 0.63–1.44; p = .82), postoperative pain (WMD, −0.42; 95% CI, −0.99 to 0.15; p = .15), conversion rate (p = .11), EBL (p = .51), or length of hospital stay (p = .27). However, single-port LH was associated with an average of 13.13 minutes longer operative time than multiport LH (p = .02). Our findings show that single-port LH is a safe and effective technique for benign gynecologic conditions, although it may require a longer operative time than multiport LH. Further large, prospective RCTs with long-term follow-up are needed to determine whether single-port LH really offers such benefits as better cosmetic outcome over multiport LH.

Single port laparoscopic hysterectomy: Feasibility and safety

Objective: To evaluate the feasibility and safety of single-port laparoscopic hysterectomy comparing with multi-port laparoscopic hysterectomy in treatment of benign uterine diseases. Methods: Data were collected retrospectively by review of the medical records of 252 patients who underwent multi-port or single-port laparoscopic surgery for treatment of benign gynecologic diseases. Laparoscopy assisted vaginal hysterectomy (LAVH) was performed for single-port surgery and LAVH and total laparoscopic hysterectomy (TLH) were performed for multi-port surgery. Demographic variables were collected and analyzed by independent t-test and Pearson Chi-Square test. The primary outcome was analyzed by independent t-test and Fisher’s Exact test. Results: A longer operative time was observed in the multi-port surgery group compared with that of the single-port group (p laparotomy conversion and complications were observed between the two groups. Conclusion: Single-port laparoscopic hysterectomy for treatment of benign uterine diseases is a safe and feasible method.