Single-port Access Total Laparoscopic Hysterectomy Research Articles

Feasibility and Surgical Outcomes of Hybrid Robotic Single-Site Hysterectomy Compared with Single-Port Access Total Laparoscopic Hysterectomy.

We compared surgical outcomes between single-port access total laparoscopic hysterectomy (SPA-TLH) and hybrid robotic single-site hysterectomy (RSSH), a new technique of combining the benefits of SPA-TLH with RSSH in this study. A total of 64 patients were retrospectively analyzed. They underwent either hybrid RSSH or SPA-TLH for benign gynecologic disease between December 2018 and August 2021. To assess the feasibility of hybrid RSSH, the clinical characteristics and surgical outcomes were compared between the hybrid RSSH group (n = 29) and the SPA-TLH group (n = 35). All of the surgeries were completed without requiring additional ports or conversion to laparotomy. The surgical outcomes including total operative time, uterine weight, estimated blood loss, hemoglobin changes, length of hospital stay, and postoperative pain scores were not significantly different between the two groups. The colpotomy time, including the detachment of the uterosacral and cardinal ligaments, was shorter in the hybrid RSSH group than in the SPA-TLH group (8.0 min vs. 14.0 min; p = 0.029). However, the vaginal cuff closure time was longer in the hybrid RSSH group than in the SPA-TLH group (15.0 min vs.10.0 min; p = 0.001). No difference was observed with regards to intraoperative and postoperative complications. Hybrid RSSH appears to be a feasible procedure for hysterectomy in patients with benign gynecologic diseases.

Comparison between transumbilical and transvaginal morcellation of a large uterus during single-port-access total laparoscopic hysterectomy.

ObjectiveTo compare the perioperative outcomes of transumbilical morcellation (TUM) and transvaginal morcellation (TVM) of a large uterus (≥500 g) during single-port-access total laparoscopic hysterectomy (SPA-TLH).MethodsA total of 57 patients who underwent SPA-TLH for a large uterine myoma and/or adenomyosis (uterine weight ≥500 g) between March 2013 and July 2017 were included. For specimen retrieval, TUM was performed for 30 patients and TVM for 27 patients.ResultsPerioperative outcomes, including total operative time, tissue extraction time, extension of skin incision length, estimated volume of blood loss, changes in postoperative hemoglobin level, length of postoperative hospital stay, postoperative pain, and uterine weight, were compared between the 2 groups. No significant differences were observed in the baseline characteristics except for a history of cesarean section (TUM vs. TVM: 83.3% vs. 14.8%, P=0.002) and history of vaginal delivery (TUM vs. TVM: 6.7% vs. 88.8%, P=0.001). The total operative time, tissue extraction time, extension of skin incision length, estimated volume of blood loss, changes in postoperative hemoglobin level, length of postoperative hospital stay, and postoperative pain did not significantly differ between the two groups. The uterine weight was significantly higher for patients who underwent TUM than for those who had TVM (median [range]: 735 g [520–1,380 g] vs. 622 g [514–975 g]; P=0.042).ConclusionTUM during SPA-TLH is a feasible technique for extracting large uteri weighing ≥500 g. This procedure is suitable for patients without a history of vaginal delivery or a narrow vaginal cavity.

Scheduled injection of ramosetron for prevention of nausea and vomiting following single-port access total laparoscopic hysterectomy: a prospective randomized study.

ObjectiveThe purpose of this study was to evaluate the effectiveness of scheduled ramosetron injections for controlling postoperative nausea and vomiting (PONV) after single-port access total laparoscopic hysterectomy (SPA-TLH).MethodsNinety patients who underwent SPA-TLH at the Korean National Health Insurance Service Ilsan Hospital between June 2013 and July 2014 were enrolled in this prospective, randomized, double-blinded, placebo-controlled study. The patients were divided into 2 groups as follows: the ramosetron group (0.3 mg intravenously [IV]; n=45) and the placebo group (normal saline IV; n=45). Both groups received their respective injections 12 and 24 hours post surgery. The incidence and severity of PONV (numerical rating scale, 0–10), and the use of rescue antiemetics post surgery were evaluated.ResultsDemographic and perioperative statistically significant differences were not observed between the 2 groups. The incidence of PONV in the ramosetron and placebo groups was 46.7% and 51.1%, respectively (P=0.51). We found significant differences in the severity of PONV between the 24- to 48-hour postoperative periods in both groups (ramosetron group, P=0.04 and placebo group, P=0.03). The use of rescue antiemetics was significantly lower in the ramosetron group than in the placebo group (P=0.02).ConclusionAfter general anesthesia, scheduled injections of ramosetron 12 and 24 hours after SPA-TLH reduced the severity of PONV and the use of rescue antiemetics. Administration of ramosetron can be considered not only immediately after SPA-TLH but also during the first 24-hour recovery period.Trial RegistrationClinicalTrials.gov Identifier: NCT 02011659

Postoperative Pain After Total Laparoscopic Hysterectomy: A Comparison of Transumbilical Single-Port Access and Conventional Three-Port Laparoscopic Surgery

To compare postoperative pain between single-port access total laparoscopic hysterectomy (SPA-TLH) using a trans-umbilical single-port system and conventional multi (three)-port access total laparoscopic hysterectomy (MPA-TLH).

Single-port access total laparoscopic hysterectomy with Korean-made OCTO Port: Turkish surgeons’ initial experience

We present our initial experience with single-port access total laparoscopic hysterectomy (TLH) surgery using a Korean-made laparoscopic port (OCTO™ Port). In a retrospective study, single-port access TLH (SPA-TLH) with the OCTO Port was performed on 34 patients with benign gynaecological indications from July 2013 to May 2014 by two surgeons (Ahmet Kale and Hasan Terzi). All patients were divided into two groups. The first 15 patients who underwent SPA-TLH were classified as Group 1, and the second 19 patients who underwent SPA-TLH were classified as Group 2. Patient data were analyzed for age, body mass index (BMI, kg/m2), weight of uterus, vaginal cuff suturation time, estimated blood loss, operation time, hysterectomy indications and operative outcomes. The median time needed for the surgery was 75 min in both groups. The duration of suturing of the vaginal cuff was shorter in Group 2 compared with that in Group 1. The estimated blood loss was less in Group 2 compared with Group 1: Four patients in Group 1 required blood transfusion while none of the patients in Group 2 required blood transfusion. The OCTO Port has soft and flexible instrumental movements, which can reduce crowding of instruments during surgery, and the cap rotates 360 degrees. The OCTO Port might facilitate the learning curve of single-port laparoscopic hysterectomy surgery.

Feasibility and early outcomes of single-port access total laparoscopic hysterectomy among Chinese patients.

International Journal of Gynecology & ObstetricsVolume 131, Issue 2 p. 206-207 Brief communications Feasibility and early outcomes of single-port access total laparoscopic hysterectomy among Chinese patients Junji Zhang, Junji Zhang Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, ChinaSearch for more papers by this authorDawei Sun, Corresponding Author Dawei Sun sundw1118@aliyun.com Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, ChinaCorresponding author at: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Wangfujing Shuaifuyuan 1#, Dongcheng District, Beijing 100730, China. Tel./fax: + 86 10 69156204.Search for more papers by this authorJinghe Lang, Jinghe Lang Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, ChinaSearch for more papers by this author Junji Zhang, Junji Zhang Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, ChinaSearch for more papers by this authorDawei Sun, Corresponding Author Dawei Sun sundw1118@aliyun.com Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, ChinaCorresponding author at: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Wangfujing Shuaifuyuan 1#, Dongcheng District, Beijing 100730, China. Tel./fax: + 86 10 69156204.Search for more papers by this authorJinghe Lang, Jinghe Lang Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, ChinaSearch for more papers by this author First published: 05 August 2015 https://doi.org/10.1016/j.ijgo.2015.05.018Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume131, Issue2November 2015Pages 206-207 RelatedInformation

当院における単孔式腹腔鏡下手術の改良点～プリベンド鉗子および5mm径ロングスコープの使用～

Introduction: Transumbilical single-port access laparoscopic surgery has a lower rate of incisional morbidity and a favorable cosmetic outcome. However, the procedure is sometimes difficult to perform because of collision between the forceps and the scope. Therefore, we have used pre-bent forceps and a 5 mm-diameter long scope since April 2012. This study aims to evaluate the feasibility and efficacy of the revised single-port access laparoscopic surgery. Methods: We evaluated 29 cases of transumbilical single-port access total laparoscopic hysterectomy (SPA-TLH) using straight forceps or pre-bent forceps. Results: The pre-bent forceps group had shorter operative times for the procedures of ligating uterine arteries, dividing the cardinal ligament, incising the vaginal wall, and suturing the vaginal stump, compared with the straight forceps group. Conclusion: SPA-TLH using a pre-bent forceps and a 5 mm-diameter long scope could be more feasible, compared with SPA-TLH without such instruments.

Operative outcomes of single-port-access laparoscopy-assisted vaginal hysterectomy compared with single-port-access total laparoscopic hysterectomy

ObjectiveThis study aims to compare between operative outcomes of single-port-access laparoscopy-assisted vaginal hysterectomy (SPA-LAVH) and single-port-access total laparoscopic hysterectomy (SPA-TLH), further subdivided by vaginal cuff closure via laparoscopic suture (VCC-L) or via the vaginal route (VCC-V). Materials and methodsA custom-made port was used for single-port laparoscopy in 111 patients who underwent SPA-LAVH (n = 33), SPA-TLH with VCC-L (n = 35), and SPA-TLH with VCC-V (n = 43) during October 2009–October 2010. Records were reviewed retrospectively. ResultsA significant difference in the operating time was observed among the groups (p = 0.009). SPA-TLH with VCC-L took a significantly longer time to be performed (118.6 ± 41.8 minutes) than SPA-TLH with VCC-V (98.6 ± 21.3 minutes) or SPA-LAVH (102.0 ± 20.3 minutes). The decrease in hemoglobin level on the 1st day postsurgery was significantly smaller in case of SPA-LAVH (1.56 ± 0.97 g/dL, p = 0.005) compared with that in case of SPA-TLH with VCC-L (2.19 ± 0.95 g/dL) and SPA-TLH with VCC-V (2.24 ± 0.95 g/dL). No significant differences in other surgical outcomes were found. ConclusionSPA-TLH with laparoscopic vaginal suture required the longest operating time, and hemoglobin changes were smaller in the SPA-LAVH group than in the other groups. In patients undergoing SPA laparoscopy, we recommend the SPA-LAVH procedure.

Laparoscopic vaginal vault closure with conventional straight instruments in single-port access total laparoscopic hysterectomy

ObjectiveLaparoscopic vaginal vault closure with conventional straight instruments is the final barrier to single-port access total laparoscopic hysterectomy (SPA-TLH). The aim of this study is to find out the safer, easier, simpler, faster, and even cheaper way to overcome it.MethodsVaginal vault suturing techniques of 152 consecutive single-port access total laparoscopic hysterectomy cases performed by the author in Gangnam CHA Hospital, CHA University from October 1, 2003 to June 30, 2012, were retrospectively analysed with medical records and DVDs.ResultsOf 152 patients who were attempted SPA-TLH, 119 patients (78%) were finished their operations without conversion to multi-port laparoscopy or laparotomy. Of women with successful SPA-TLH, 8 cases (7%) were closed their vaginal vaults vaginally (median, 20 minutes; range, 15-44 minutes), and 111 cases (93%) laparoscopically (median, 44 minutes; range, 13-56 minutes). Laparoscopic vault closure techniques were continuous suture (4 cases, 3%; median, 36 minutes; range, 30-45 minutes), interrupted sutures using knot-pusher (7 cases, 6%; median, 52 minutes; range, 48-56 minutes) Endo Stitch suture (2 cases, 2%; median, 32 minutes; range, 13-50 minutes), continuous vault closure using percutaneous sling sutures (PCSS) (92 cases, 77%; median, 40 minutes; range, 19-56 minutes), and continuous vault closure without PCSS (6 cases, 5%; median, 23 minutes; range, 16-31 minutes).ConclusionLaparoscopic vault closure using PCSS in SPA-TLH only with conventional straight instruments is the best way to overcome the barrier and the short-cut to shorten the learning curve to date.

Single-Port Access Total Laparoscopic Hysterectomy for Large Uterus

Background/Aims: To evaluate the feasibility and safety of single-port access total laparoscopic hysterectomy (SPA-TLH) for large uterus (>500 g). Methods: A prospective data collection was performed in 21 consecutive patients in March 2010 and August 2011. Surgical outcome including operative time (OT) and estimated blood loss (EBL) were analyzed. Results: SPA-TLH procedures were successfully performed in 16 cases (76.2%). Of the 5 failed cases, 4 were converted to multiport TLH because of distorted uterine contours and pelvic adhesions and 1 was converted to laparotomy for bleeding control. The median OT, uterine weight, and EBL were 110 (65–165) min, 600 (502–980) g, and 200 (100–800) ml, respectively. Spearman’s correlation analysis demonstrated that OT and blood loss increased with increasing uterine weight (p = 0.003 and p = 0.033, respectively). No operative complications were observed during the hospital stay and 3-month follow-up following discharge. Conclusion: SPA-TLH for large uterus is a feasible and safe technique.

Learning Curve and Surgical Outcome for Single-Port Access Total Laparoscopic Hysterectomy in 100 Consecutive Cases

Aims: To define the learning curve for single-port access (SPA) total laparoscopic hysterectomy (TLH) and evaluate the surgical outcomes. Methods: Patient demographics and segmental operating times of all 100 patients who underwent SPA-TLH by a single surgeon were analyzed. Patients were arranged in order based on surgery date. Results: 100 patients underwent SPA-TLH. There was no conversion to conventional laparoscopy or laparotomy. The median time until the removal of a specimen (T_R) was 45 min and the median time for closure of the vaginal cuff (T_C) was 18 min. The median total operating time from skin opening to closure (T_O) was 80 min. T_R, T_C, and T_O decreased significantly over the study period. The T_C decreased significantly from the first 20 cases to the next 20 (p = 0.028) and the T_O from the second 20 cases to the next 20 (p = 0.029). Conclusions: Proficiency for SPA-TLH was achieved after 40 cases. Operating time and postoperative hemoglobin drop decreased with experience, without increasing complication.

The Learning Curve and Surgical Outcome for Single-Port Access Total Laparoscopic Hysterectomy in 100 Consecutive Cases

The Learning Curve and Surgical Outcome for Single-Port Access Total Laparoscopic Hysterectomy in 100 Consecutive Cases

Transumbilical single-port access versus conventional total laparoscopic hysterectomy: surgical outcomes

The objective of the study was to compare surgical outcomes and postoperative pain between transumbilical single-port access total laparoscopic hysterectomy (SPA-TLH) and conventional 4-port total laparoscopic hysterectomy (TLH). We retrospectively reviewed 157 patients who underwent SPA-TLH (n = 52) or conventional TLH (n = 105). A single-port access system consisted of a wound retractor, surgical glove, 2 5 mm trocars, and 1 10/11 mm trocar. The SPA-TLH group had less intraoperative blood loss (P < .001), shorter hospital stay (P = .001), and earlier diet intake (P < .001) compared with the conventional TLH group. There was no difference in perioperative complications. Immediate postoperative pain score was lower in the SPA-TLH group (P < .001). Postoperative pain after 6 and 24 hours was lower in SPA-TLH with marginal statistical significance. SPA-TLH is a feasible method for hysterectomy with lower immediate postoperative pain and better surgical outcomes with respect to recovery time compared with conventional TLH.