Single-port Laparoscopic Cystectomy Research Articles

Comparison of the impact of single-port laparoscopic and conventional laparoscopic ovarian cystectomy on the ovarian reserve in adult patients with benign ovarian cysts

Objective: The surgical approach, hemostatic approach, histologic findings, and cyst size and location may have a role in reducing the ovarian reserve. The aim of this study was to investigate the impact of single-port laparoscopic cystectomy (SLC) and conventional laparoscopic cystectomy (CLC) on the ovarian reserve based on serum anti-Mullerian hormone (AMH) concentrations.Material and methods: This non-randomized concurrent control trial enrolled 79 female patients aged 18–45 years with benign ovarian cysts, including 47 patients in the SLC group and 32 patients in the CLC group. Outcome measures, including hospital stay, operative time, blood loss, analgesic use, body temperature, hospitalization cost, and serum AMH concentration, were evaluated preoperatively, two to three days postoperatively, and four to six weeks postoperatively.Results: The reduction in the AMH concentration after cystectomy was significantly different preoperatively, two to three days postoperatively (p < .001), and four weeks postoperatively (p < .001) regardless of the surgical approach (SLC or CLC) [F (1.00,31.00) = 0.026, p = .873]. Moreover, the hemostatic approach and histologic findings yielded significant differences in the serum AMH concentration regardless of the surgical approach (p < .05). The serum AMH concentration was higher in unilateral cysts (2.70 ± 1.80 ng/mL) than in bilateral cysts (1.73 ± 1.11 ng/mL) postoperatively (p < .05). In the SLC group, the serum AMH concentration in the patients with ovarian endometriomas (1.58 ± 1.39 ng/mL) was significantly lower than that in the patients with other cysts (3.22 ± 1.68 ng/mL) postoperatively (p < .05).Conclusion: The serum AMH concentration decreased over time postoperatively but did not significantly differ between SLC and CLC.

Single-port compared with conventional laparoscopic cystectomy for ovarian dermoid cysts

ObjectiveWe compared the immediate surgical outcomes of single-port laparoscopic cystectomy (SLC) and conventional laparoscopic cystectomy (CLC) for managing ovarian dermoid cysts. Materials and methodsA retrospective case-control study was conducted to enroll 71 patients with dermoid cysts, including 34 patients in the SLC group and 37 patients in the CLC group. The outcome measures included operative time, blood loss, postoperative pain, analgesic use, and serum levels of hormones, including estrogen (E2), follicle-stimulating hormone, luteinizing hormone, and anti-Mullerian hormone. ResultsSLC was associated with less time required for specimen retrieval (1.3 ± 0.8 vs. 12.0 ± 3.4 minutes, p < 0.001), fewer ruptured bags (0% vs. 10.8%, p = 0.049), and less need of additional wound elongation (0% vs. 27.0%, p = 0.001) when respectively compared with CLC. Additionally, patients who underwent SLC reported lower postoperative lower abdominal pain and less accumulated postoperative analgesics when respectively compared with patients who underwent CLC. There was no significant difference of hormones between two groups. ConclusionOur study demonstrated the feasibility of using the single-port method in place of CLC in the management of ovarian dermoid without increased difficulty of techniques or risk of ovarian damage.

Single-port laparoscopic cystectomy and intracorporeal urinary diversion assisted by transurethral access: preliminary study

Objective To make attempt for"no scar"cystectomy by pure LESS(laparoendoscopic single-site)surgery and transurethral NOTES(natural orifice transluminal endoscopic surgery)in pigs,so as to assess the feasibility and summarize the experience.Methods Female pigs weighing 30kg were given general anesthesia.A 2cm incision was made through the right lateral border of the rectus muscle,and the subcutaneous tissues and muscle layer were dissected bluntly with the Kelly clamp.The SILS port was introduced into the peritoneal cavity and the pneumoperitoneum was established.The bladder was dissected by the flexible forceps and scalpel.And the ureters and urethra were divided.Under the guidance of ureteroscopy,a 12mm trocar was introduced into the urethra.Through the transurethral access,the small intestine was divided by two Endo GIAs.The lateral-lateral anastomosis of intestine and the left side of ureter-intestinal anastomosis were performed with assistance of the transurethral access.After the specimens were retracted,the urethra was closed by 2-0suture.After the SILS port was removed,the right ureter and the small intestine for the stoma were pulled out of the peritoneal cavity.The right side of ureter-intestinal anastomosis was done outside of the body.Then the stoma was performed.Results Three cases were performed in a mean of(275±63)min(ranging from 210-335min)without additional trocars.Except for the stoma,there were no other incisions on the surface of the abdominal wall.Conclusion This "no scar"LESS radical cystectomy can be performed successfully with assistance of the transurethral access in pigs,but the operation is technically difficult.