Single-port Laparoscopic Hysterectomy Research Articles

Technical, ergonomic and cognitive learning methodology in transumbilical single-port laparoscopic hysterectomy.

We introduced learning curves on a detailed step protocol and ergonomic aspect to determine key surgical points in transumbilical single-port laparoscopic hysterectomy (TSPLH) and to popularize both technical and cognitive methodology on laparoendoscopic single-site surgery (LESS). A retrospective analysis of 87 TSPLH procedures was conducted by a single surgeon in three learning stages. Technical, ergonomic, and cognitive steps were introduced, and surgical outcomes were analyzed. Key production points in TSPLH include developing a clear retroperitoneal space, maintaining appropriate strength and direction with a vaginal manipulator, coagulating the uterine artery, and applying an improved vaginal stump suturing method. Technical factors included instrument domination, hand-eye coordination, and alternating hand functions. Ergonomic techniques focused on shoulder, elbow, arm, wrist, and finger movements, range of motion, muscle power, continuous forces, and flexibility. Improved cognitive factors such as confidence, decision-making, and communication were also observed. The study aimed to form methodological education on TSPLH and LESS and benefit more surgeons. The detailed production and key ergonomic points will help guide self-learning and education.

Comparison of Surgical Outcomes between Single-Port Laparoscopic Surgery and Da Vinci Single-Port Robotic Surgery

The aim of this study is to compare the surgical outcomes of single-port laparoscopic surgery (SPLS) and single-port robotic surgery (SPRS). We retrospectively analyzed patients who underwent a hysterectomy, ovarian cystectomy, or myomectomy with SPLS or SPRS from January 2020 to July 2022. Statistical analyses were performed using the SPSS chi-square test and student's t-test. A total of 566 surgeries including single-port laparoscopic hysterectomy (SPLH; n = 148), single-port robotic hysterectomy (SPRH; n = 35), single-port laparoscopic ovarian cystectomy (SPLC; n = 207), single-port robotic ovarian cystectomy (SPRC; n = 108), single-port laparoscopic myomectomy (SPLM; n = 12), and single-port robotic myomectomy (SPRM; n = 56). The SPRH, SPRC, and SPRM groups had a shorter operation time than the SPLS group, although the results were not statistically significant (SPRH vs. SPLH, p = 0.134; SPRC vs. SPLC, p = 0.098; SPRM vs. SPLM, p = 0.202). Incisional hernia occurred as a postoperative complication in two patients only in the SPLH group. Postoperative Hb changes were lower in the SPRC and SPRM groups than in the SPLC and SPLM groups (SPRC vs. SPLC, p = 0.023; SPRM vs. SPLM, p = 0.010). Our study demonstrated that the SPRS had comparable surgical outcomes when compared to the SPLS. Therefore, the SPRS should be considered a feasible and safe option for gynecologic patients.

Preclinical evaluation of the new EDGE SP 1000 single-port robotic surgical system in gynecology minimal access surgery.

The aim of this study is to evaluate the feasibility and safety of a new single-port robotic surgical system for gynecological surgery in the porcine model. Six female Tibetan miniature pigs underwent robot-assisted single-port laparoscopic total hysterectomy with the newly developed single-port EDGE SP1000 platform. Estimated blood loss (EBL), docking time, operative time, and intraoperative and postoperative complications were recorded. Postoperative pain was assessed by VAS (visual analog scale) score at 6h, 12h, 24h, and 48h. Then the experimental animals were observed for one week after surgery to assess their mental status, incisional infections and finally euthanized for necropsy to assess the recovery of the vaginal stump. Six hysterectomies of pigs were successfully completed. There were no significant intraoperative complications in the six surgeries. The average total operation time was 113.33min (95-143min), and the average docking time was 5.5min (4-7min). The average EBL was 10ml (5 ~ 20ml). The mean VAS scores at 6, 12, 24, and 48h postoperatively were 6.3, 5.7, 5, 3, respectively. At 7days postoperatively, no significant incisional infections or other complications were observed. Post-euthanasia examination of the pelvis showed no significant abnormalities in the vaginal stump. This preclinical study of a new single-port surgical system for gynecologic procedures demonstrated the safety and feasibility of the EDGE SP1000 system in porcine models. Further studies are required to assess its clinical utility in the future.

Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery versus single-port laparoscopy: Comparison of early outcomes.

The study objective was to compare intraoperative and early postoperative outcomes among patients who underwent hysterectomy via transvaginal natural orifice transluminal endoscopic surgery (and single-port lararoscopy for presumed benign gynecologic disorders). We retrospectively reviewed 40 patients who underwent single-port laparoscopic hysterectomy and 20 patients who underwent hysterectomy via natural orifice transluminal endoscopic surgery. Patients' age, body mass index, history of previous delivery and surgery, total operation time (from skin incision to closure), intraoperative and postoperative complications conversion to another surgical procedure, drop of hemoglobin level, postoperative pain at 1 and 18 h, average hospital stay, and clinical outcomes were analyzed. Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery was superior to single-port hysterectomy concerning the length of hospitalization (p < 0.001) and visual analog scale at 1h (p=0.024) and 18 h (p < 0.001). In transvaginal natural orifice transluminal endoscopic group, postoperative complications were lower than single-port laparoscopy group (p=0.023). In transvaginal natural orifice transluminal endoscopy, group conversion to a standard vaginal hysterectomy occurred in two cases (10%). Four patients in the single-port laparoscopic hysterectomy group had umbilical herniation, three had port-site infections, and two patients had vaginal cuff hematoma. These patients required rehospitalization. Despite hysterectomy via transvaginal natural orifice transluminal surgery has not yet found its place in routine practice in gynecology departments, it could be a prominent alternative approach to other minimally invasive surgical procedures in selected patients with many advantages including lesser pain and lower complication rates compared with single-port laparoscopic hysterectomy.

Single-port laparoscopic hysterectomy and bilateral salpingectomy for a patient with abnormal uterine bleeding-adenomyosis

Single-port laparoscopic hysterectomy and bilateral salpingectomy for a patient with abnormal uterine bleeding-adenomyosis

Evaluation of Inflammatory Markers in Single-Port Laparoscopic and Vaginal Hysterectomies: A Retrospective Study in Kocaeli, Northwest Turkey

Objective: The authors in this study aimed to detect inflammatory marker changes in two natural orifice hysterectomies: single-port laparoscopic hysterectomy (SLH) and vaginal hysterectomy (VH). Materials and Methods: Between 2018 and 2019, data obtained from patients in the SLH and VH groups were reviewed retrospectively. The preoperative and postoperative hematocrit (HCT), hemoglobin (HB), white blood cell (WBC), platelet (PLR), and neutrophil-lymphocyte (NLR) ratios and values were compared as well as the demographic characteristics of the patients. This study was also registered in Registry of Clinical Trials; registration number: NCT04221308. Results: In the postoperative period, WBC, NLR, and PLR were statistically increased, and HB and HCT were decreased in all groups. However, the changes in inflammatory markers were similar in both groups. The changes in HB and HCT were less in the SLH group. Moreover, both the duration of the operation and the hospital stay were higher in the SLH group. Conclusions: Both natural orifice techniques provided low morbidity and good cosmetic results. The results regarding inflammatory markers indicate that both procedures are acceptable. As surgical experience in performing SLH increases, operation and hospital stay durations may decrease.

Single-port laparoscopic hysterectomy for uteri greater than 500 grams

ObjectivesTo study the operative outcomes of single-port laparoscopic hysterectomy in uteri greater than 500 g, using either laparoscopic assisted vaginal hysterectomy (LAVH) or laparoscopic supracervical hysterectomy (LSH). Materials and methods78 patients were included in a single institute by a single surgeon from March, 2013 to January, 2018. ResultsThe median uterine weight was 686.5 g. Larger uterine weight was correlated with longer operative time and greater estimated blood loss. Two types of operations were performed: LAVH (n = 55) or LSH (n = 23). There were no differences in operative time (150.2 ± 45.1 vs. 158.6 ± 82.1, P = 0.66) and estimated blood loss (365.8 ± 298.5 vs. 356.5 ± 46.6, ml, P = 0.94) between LAVH and LSH. However, patients in LAVH had more excess blood loss (>500 mL) compared with LSH (32.7% vs. 21.7%, P = 0.42). In the later study period, the operative time was shorter and complication rates were lower. Such differences were especially significant in the LAVH group. By multiple regression analysis, operative time was independently correlated with age, body mass index, estimated blood loss and uterine weight in LAVH. The correlation between operative time and uterine weight in LSH was attenuated by estimated blood loss. Estimated blood loss was the dominant factor correlated with longer operative time in LSH. ConclusionsBoth LAVH and LSH could be feasible in uteri greater than 500 g. LSH appeared to have less complication and less blood loss than LAVH. Operative time was correlated significantly with bleeding amount. Therefore, better bleeding control and surgical experience were warrants for single-port laparoscopic hysterectomy in uteri greater than 500 g.

2859 Single-Port Laparoscopic Hysterectomy in Patients with Myoma Uteri

Study Objective The aim of this study is to compare surgical outcomes of single – port laparoscopic hysterectomy (SPL-H), conventional laparoscopic hysterectomy (LH) and robot-assisted hysterectomy (RH) in patients with uterine fibroids. Design Retro and prospective study. Setting City Hospital #40, The Swiss University clinic. Patients or Participants 117 patients entered the study between 2012 and 2018. 39 patients had single – port laparoscopic hysterectomy (SPL-H), 41 patients - conventional laparoscopic hysterectomy (LH), and 37 patients - robot-assisted hysterectomy (RH) for myoma uteri. Interventions single – port laparoscopic hysterectomy (SPL-H), conventional laparoscopic hysterectomy (LH), robot-assisted hysterectomy (RH). Measurements and Main Results Patient characteristics, operating time, estimated blood loss, length of hospital stay, rate of complications, postoperative pain scores and cosmesis were compared. Mean operating time (min) in the group of SPL-H was 109,1±24,8 (95% CI: 101,1-117,2 min), in comparison with LH -104,8±26,2 min (95% CI: 96,5-113,0 min), р=0,847. The total duration of surgery in the group of robot-assisted laparoscopy was 185.1±50.5 min. Estimated blood loss (ml) did not differ statistically in the group of single - port and conventional laparoscopic hysterectomy (Me 80 ml, p=0,083). The hospital stay (days) in a group of SPL-H was significantly lower compared to both groups robotic and conventional laparoscopy (p=0.018 and p=0.034, respectively), while the differences in this two groups were insignificant (p=0.777). There were no conversions to abdominal hysterectomy. In one case of single-port hysterectomy (2.56%), an additional trocar was required due to the atypical localization of the myoma. There were 2 cases with complications in the group of SPL-H who had required relaparoscopy, in the group of RH - 1 case. In the group of traditional laparoscopy there were no complications. All complications in SPL-H group were at the stage of development of the method. Conclusion Single-port hysterectomy is a feasible and safe technique, with no major complications compared to conventional and robotic access.

2094 Single-Port Laparoscopic Hysterectomy without Uterine Manipulator in Early Cervical Cancer

Video Objective To present the advanced single port laparoscopic hysterectomy without a uterine manipulator in early cervical cancer. Setting A 42-year-old woman(G2P2) undertook surgery diagnosed with cervical cancer in PAP smear and punch biopsy. She had no past medical history. There was neither evidence of definite burging mass in the cervix nor any metastasis in the preoperated abdominal computed tomographic imaging. Two ml (2.5 mg/mL) of ICG solution was prepared in a 10 ml syringe to inject directly into the cervix. We recorded video with 30° 10 mm scope equipped with a specific lens and light source emitting both visible and NIR light (Stryker 1588 AIM, Stryker Co., ABK, MI, USA). Interventions Under general anesthesia, we performed laparoscopic single port hysterectomy and both salpingectomy and sentinel lymph node biopsy. During the surgery, we didn't inserted both uterine manipulator and foley catheter. we used only the colpotomizer cup just before cutting the uterus. we also used a retrieval bag when removing the uterus from the abdominal cavity. Pathology revealed invasive squamous cell carcinoma and no sentinel lymph node metastasis. Conclusion We successfully performed the single port laparoscopic hysterectomy not using a uterine manipulator for the early cervical cancer without any complication and that would be helpfull reducing the risk of tumor reccurence.

2122 5mm Mini Single Hole Incision Laparoscopic Hysterectomy: Series of Five Cases

Study Objective To investigate the feasibility and safety of single-port laparoscopic hysterectomy with 5mm mini incision. Design The clinical data of 5 patients who underwent 5mm mini-incision single-port laparoscopic hysterectomy were retrospectively analyzed. Setting Department of Obstetrics and Gynecology, C the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University. Patients or Participants 5 patients who underwent 5mm mini-incision single-port laparoscopic hysterectomy. Interventions The median longitudinal incision of the umbilicus is about 5mm long, and the subcutaneous sneak expansion space is 3-5mm. The 40/50 small abdominal retractor expands and retracts the incision approach, using small lenses such as pediatric surgical laparoscopy, cystoscopy or hysteroscopy. Place the operating instrument to perform the operation. Measurements and Main Results Five patients in this group were successfully operated. No other channels were added during the operation, and no laparotomy was performed. The operation time is 100-195 min, in which the puncture establishes the surgical access part for 5-10 min, and the umbilical hole reconstruction part 3-5 min; The intraoperative blood loss was 50-100 ml, the body temperature was 36.5°C to 37.5°C after 1 day, and the anus exhaust time was 1.0-1.5 days. The patient was discharged from hospital for 6-7 days. The postoperative umbilical wounds healed well, almost no surgical scars were seen, and no postoperative umbilical hernia and other serious complications occurred. Conclusion Under the premise of mature laparoscopic technique, it is safe and effective to perform a 5mm mini incision laparoscopic hysterectomy.

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.

Comparison of Different Surgical Approaches for Hysterectomy: A Single-Institution Experience

Objective: We aimed to compare surgical outcomes and postoperative complications among different hysterectomy approaches such as total abdominal hysterectomy, vaginal hysterectomy, multiport access laparoscopic hysterectomy, and single-port access laparoscopic hysterectomy.Study Design: This retrospective, single institution, case control study was carried out at the Obstetrics and Gynecology Department of Baskent University in Ankara, Turkey. We evaluated 86 consecutive patients who underwent hysterectomy for benign gynecological conditions.Results: A total of 86 women underwent hysterectomy: 20 (23.3%) total abdominal hysterectomy, 20 (23.3%) vaginal hysterectomy, 27 (31.3%) multiport access laparoscopic hysterectomy, and 19 (22.1%) single-port access laparoscopic hysterectomy using a transumbilical single-port system. There was no significant difference in uterine size between groups (Z=5.705; p=0.127). A statistically significant (p&lt;0.001) difference in operation time (duration of surgery) was observed among the following groups. The duration of surgery for the multiport access laparoscopic hysterectomy, and single-port access laparoscopic hysterectomy groups was similar, with these two laparoscopic procedures requiring significantly more time than total abdominal hysterectomy and vaginal hysterectomy procedures. There was no statistically significant difference in between hemoglobin levels before and after operation between groups. There was no statistically significant difference between groups in intraoperative and postoperative complications. Six patients experienced complications, one intraoperative and five postoperative. Intraoperative complication was ureter injury in single-port access laparoscopic hysterectomy group. The postoperative complication rate was 5.8% (5 cases) in 86 patients. Perirectal abscess in one patient and wound infection in two patients occurred in total abdominal hysterectomy group (15%). Urinary tract infection in one patient and vaginal cuff cellulitis in one patient occurred in vaginal hysterectomy group (4%). No complications were reported in multiport access laparoscopic hysterectomy, and single-port access laparoscopic hysterectomy groups. Post-surgery, all patients who underwent single-port access laparoscopic hysterectomy reported that they were satisfied with their incision and cosmetic results.Conclusions: When technically feasible, multiport access laparoscopic hysterectomy, and single-port access laparoscopic hysterectomy may be performed instead f total abdominal hysterectomy because of rapid recovery and shorter hospitalization however there are longer operating time.

A comparison of novel laparoscopic suturing techniques in single-port surgery

Objective: To compare the vaginal cuff closure times of a newly developed Turkish-made laparoscopic needle holder (TMLNH) and a Yoon Soon (YS) extracorporeal knot tying technique in the closure of the vaginal cuff during single-port laparoscopic hysterectomy.Material and methods: We retrospectively reviewed a total of 60 consecutive patients who underwent single-port laparoscopic hysterectomy using a TMLNH (n = 30) or a YS extracorporeal knot tying technique (n = 30).Results: The patients’ demographic data, operative results, and complications were analyzed. Operative time and the time required for vaginal cuff suturing were significantly shorter in the TMLNH group than in the YS extracorporeal knot tying group (60.1 ± 3.2 vs. 77.3 ± 6.0 min, p = .001 and 24.5 ± 3.7 vs. 36.3 ± 3.8 min, p = .001, respectively). The intraoperative and postoperative complications were comparable in both groups.Conclusion: The use of TMLNH for vaginal cuff closure in single-port hysterectomy reduced the operative time and the time required for vaginal cuff suturing. However, both TMLNH and YS extracorporeal knot-tying technique may enable the surgeons to overcome the surgical challenges of SPA surgery.

GnRHa Before Single-Port Laparoscopic Hysterectomy in a Large Barrel-Shaped Uterus.

Background and Objectives:Laparoscopic hysterectomy for a large barrel-shaped uterus is difficult. We assessed the feasibility of single-port laparoscopic hysterectomy in a large barrel-shaped uterus after gonadotropin-releasing hormone agonist (GnRHa).Methods:We retrospectively reviewed 39 patients with a large barrel-shaped uterus who were treated with GnRHa (leuprolide acetate) before single-port laparoscopic hysterectomy. During the same period, 134 patients without GnRHa pretreatment were included as control subjects.Results:Patients with GnRHa treatment had an average increase in hemoglobin of 3.0 mg/dL and a decrease in uterine weight of 330.9 g (40.1%). Ancillary ports were required in 2 patients in the treatment group and none in the control group. There were no differences in uterine weights, operative time, and estimated blood loss in the 2 groups of patients. The estimated average operative time was shortened by 34 min after GnRHa treatment. However, bladder and ureter injuries were marginally higher (10.3% versus 2.2%) and days of hospital stay (3.7 versus 3.1) were significantly longer in the treatment group compared with controls. Complication rates were correlated with previous operative history, pelvic adhesion, and larger uterine weight but not with GnRHa treatment and operative sequence.Conclusions:GnRHa pretreatment in patients with a large barrel-shaped uterus during SPH is feasible with shortened operative time. However, the higher complication rates in these patients suggest that a weight-reduced barrel-shaped uterus that is achieved with GnRHa treatment could still be difficult and should be handled in cautious.

The Power Law of Learning in Transumbilical Single-Port Laparoscopic Subtotal Hysterectomy

Study ObjectiveTo analyze the surgical outcomes and learning curve of transumbilical single-port laparoscopic subtotal hysterectomy, which requires sutures of the cervical stump. DesignA prospective observational study (Canadian Task Force classification II-2). SettingA university-affiliated center. PatientsFrom the first (July 2012) and consecutive patients of benign uterine disease scheduled for subtotal hysterectomy until October 2013. InterventionsAll single-port laparoscopies were performed using straight instruments by 1 gynecologist. An ancillary port was added whenever technical difficulties could endanger surgical quality. Measurement and Main ResultsSeventy-five patients were recruited for intention-to-treat analysis with a mean (±SD) age of 44.7 ± 3.8 years and a body mass index of 24.2 ± 3.7 kg/m2. No major complication was noted. The mean uterine weight was 432.5 ± 344.0 g with 24 (32%) uteri ≧500 g. The patients' sequential order, or gradually increasing experience, was the determining factor in progressively decreasing operative time. Furthermore, most cases that required an additional ancillary port (67%) were clustered in the first 20 cases, whereas 4 were scattered after the 47th patient because of severe pelvic adhesion. The mean operative time decreased in the power law function of the patients' sequential order with a plateau achieved at the 20th patient. ConclusionThe patients' sequential order was identified as an independent factor of achieving purely single-port access, and the trend of decreasing operative time delineated the existence of a learning curve. Approximately 20 patients were needed for an experienced multiport laparoscopist to reach technical competency in the current series.

Newly Developed Laparoscopic Needle Holder That Facilitates Knot Tying Makes Vaginal Cuff Suturing Easy in Single-Port Laparoscopic Hysterectomy.

To evaluate vaginal cuff closure times of a single-port laparoscopic hysterectomy using a newly developed Turkish-made laparoscopic needle holder (TMLNH) with a single-port laparoscopic hysterectomy using a laparoscopic needle holder with pistol handle (LNHPH). We retrospectively reviewed 68 patients who underwent single-port laparoscopic hysterectomy using a TMLNH (n = 38) or a LNHPH (n = 30). Patients' age, parity, body mass index, mean operating time, mean vaginal cuff suturing time, uterine weight, estimated blood loss, drop of hemoglobin level, return of bowel activity, hospital stay, conversion to multiport access, conversion to laparotomy, and postoperative and intraoperative outcomes were analyzed. The TMLNH group had a shorter operative time ( P < .001) and a shorter vaginal cuff suturing time ( P < .001) compared with the LNHPH group during a single-port laparoscopic hysterectomy. There was no difference in intraoperative and postoperative complications. The TMLNH facilitates vaginal cuff suturing and decreases operation time during a single-port laparoscopic hysterectomy. We proposed that the TMLNH is a promising technique for suturing and vaginal cuff closure in a single-port laparoscopic hysterectomy.

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.

Total vaginal and single-port total laparoscopic hysterectomy for uterine benign diseases

Objective This study aimed to review the surgical outcomes and health-related quality of life (HRQOL) of total vaginal (TVH) and single-port total laparoscopic hysterectomy (SP-TLH) for uterine benign diseases. Study design This study included 121 patients who had undergone TVH or SP-TLH for uterine benign diseases between April 2011 and July 2012. Surgical outcomes, complications, and HRQOL were reviewed in the two groups. Preoperative and postoperative HRQOL data from the 36-item Short Form questionnaire (SF-36) were recorded for all patients. Results TVH was performed more often for the patients who had fewer previous operations (p = 0.32). In the TVH, there were fewer combined surgical procedures (p < 0.01), shorter operation times (p < 0.01), shorter vaginal stump suture times (p = 0.03) and lower complication rates (p < 0.01) than in SP-TLH. Overall, all SF-36 scales improved after surgery, except for the Social Functioning scale. There was no significant difference in any of the scales between the two groups. Conclusions TVH has equivalent effects on HRQOL as SP-TLH. SP-TLH is preferred for the cases with complicated and combined procedures.

Single-Port Retroperitoneal Hysterectomy with EnSeal

Introduction: This video shows single-port retroperitoneal hysterectomy (SP-rH) with EnSeal® device. Ligation of the uterine artery is the key procedure of single-port laparoscopic hysterectomy (SP-H). Ureteral injury followed by extensive coagulation of uterine vascular pedicles is one of the most problematic complications in SP-H.1,2 Therefore, ligation of uterine artery at its origin by the retroperitoneal approach can be a good alternative for preventing intraoperative bleeding and ureteral injury.3 Methods: A 49-year-old multiparous woman had a large uterus with adenomyosis, accompanying menorrhagia and dysmenorrhea. She underwent SP-rH at the Samsung Medical Center. Development of the retroperitoneal space and ligation of the uterine artery at its origin where it originates from the internal iliac artery were performed at the first step of SP-rH. We used the commercial single-port platform (LabSingle®; Sejong Medical, Paju, Korea) through a 2.5 cm umbilical incision. To avoid clashing between instruments, a 5-mm 30 degree-angled long laparoscope and articulating instruments (Roticulator® and Endo Shears™; Covidien, Norwalk, CT) were used. Moreover, to get more powerful traction of the uterus, a 5 mm laparoscopic myoma screw was used. An advanced energy device, EnSeal G2 45 mm (Ethicon Endo-Surgery, Blue Ash, OH), was used as a main electrosurgical instrument for dissection, coagulation, and transection of the tissue. Only for the colpotomy procedure, monopolar scissors were used. Vaginal cuff closure was performed using the V-Loc™ suture (Covidien). The uterus was removed with knife morcellation through the vagina. Results: Total operative time was 50 minutes. Time for ligation of bilateral uterine arteries was 4 minutes, 2 minutes each. Time for intracorporeal cuff closure was 6 minutes. Estimated blood loss was 100 mL and uterine weight was 367 g. There was no intra- and postoperative complication. The patient was discharged on postoperative day 3 without any complaints. Conclusion: SP-rH using versatile advanced energy device, EnSeal, is feasible. Multicenter randomized controlled study to evaluate the benefits and safety of SP-rH is ongoing. No competing financial interests exist. Runtime of video: 7 mins 15 secs

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.