Transumbilical Single-incision Research Articles

Clinical analysis of transumbilical single-incision laparoscopic cholecystectomy with totally free umbilical ring by conventional instruments

Objective: To summarize the clinical experience of transumbilical single-port laparoscopic cholecystectomy, and evaluate its clinical utility and the feasibility of widely usage. Methods: Between April 2012 and June 2017, 500 cases who underwent transumbilical single-port laparoscopic cholecystectomy with totally free umbilical ring by conventional instruments were enrolled. The clinical data were retrospectively analyzed. Results: A total of 487 patients were successfully completed the operation. In addition, 3 cases were converted to open cholecystectomy, 10 cases were converted to multi-port laparoscopy and drainage tubes were placed in 5 cases. The mean operating time of transumbilical single-port laparoscopic cholecystectomy(from the Trocars being put to the gallbladders being removed)shortened from 72.3 min to 13.2 min. The average bleeding amount was less than 10 ml. After the operation, 3 cases had delayed bile leakage and 3 cases had transient up-regulation of bilirubin at the beginning of the technique. No patients had hemorrhage and Trocar hernia. The average hospital stay of patients was 2.1 days. The cosmetic effect was remarkable during follow-up. Conclusion: The transumbilical single-port laparoscopic cholecystectomy with totally free umbilical ring by conventional instruments should be widely carried out in hospitals at all levels because of its minimal postoperative pain, rapid recovery, hidden incision, low costs and low incidence of port-site hernia.

Application of the cold cutting technique in transumbilical single-incision laparoscopic liver resection

Objective To study the application of the cold cutting technique in transumbilical single-incision laparoscopic liver resection (TUSI-LLR), and to evaluate its feasibility and treatment results. Methods The clinical data of 35 patients with liver lesions treated by transumbilical single-incision laparoscopic liver resection from 2013 to 2017 were retrospectively analyzed in Shengjing Hospital of China Medical University. In all these patients, the liver parenchyma was transected with the cold cutting technique. The operation time, intraoperative blood loss, postoperative complications, time to remove abdominal drain, and total hospital stay in the patients were analyzed. Results 11 of the 35 patients were male. The average age was (49.9±10.8) years. The average body weight was (63.2±11.1) kg. The diagnoses were hemangiomas in 18 patients, hepatolithiasis in 5 patients, malignant hepatocellular tumors in 5 patients, focal nodular hyperplasia in 3 patients, and others in 4 patients. There were 22 left lateral sectionectomies, 2 left hemihepatectomies, 11 wedge resections (8 in the left and 3 in the right). The operations were all successfully performed, with no conversion to conventional laparoscopic hepatectomy or open surgery. The average operation time was (112.2±51.0) minutes, and the intraoperative blood loss was (105.4±70.1) ml. No patients required intraoperative blood transfusion. The average surgery cost was (36 336.7±5 938.2) yuan. All patients recovered well, with no postoperative hemorrhage, bile leakage, or incisional wound infection. The average time periods for removal of the abdominal drain, and hospital stay were (4.5±1.2) days and (5.2±1.4) days, respectively. All the 35 patients were followed up (1~3 months), with no patients complaining of abdominal distension or abdominal pain. Conclusions The cold cutting technique in transumbi-lical single-incision laparoscopic liver resection was safe and feasible. Its benefits included the operative speed, the small amount of intraoperative blood loss and the rapid postoperative recovery of the patients. Key words: Cold cutting technique; Liver resection, laparoscopic, single incision; Stapling devices

Update on Transumbilical Single-Incision Laparoscopic Assisted Appendectomy (TULAA) - Which Children Benefit and What are the Complications?

Transumbilical laparoscopic-assisted appendectomy (TULAA) is fast and cost-effective since no endoloops, staplers or wound protection devices are used. We analyzed the effects of TULAA as first approach for perforated (PA) and non-perforated (NPA) appendicitis in children. We performed a retrospective analysis of 181 children for whom TULAA was the first approach for appendicitis between October 2010 and March 2016. Morbidity, additional laparoscopic instrument insertion (AI), conversions to open extraumbilical appendectomy (OC), and complications were evaluated. TULAA was initiated in 181 (87.4%) children (113 boys: 68 girls). Median age was 10.3 years (3.3-13.9 years) and BMI 16.8 kg/m2 (12.4-30.8). Appendicitis was non-perforated in 157 (86.7%) and perforated in 24 (13.3%) patients. TULAA was finalized in 142 (78.5%) patients, AI were inserted in 20 (11%) and OC were performed in 19 (10.5%) patients. Duration of surgery did not exceed 20 min for 12.8%, and 30 min for 43.6% of patients with TULAA and NPA. The rate of wound infections did not differ between procedures (TULAA 3/142 (2.1%), AI 0 (0%), OC 1/19 (5.3%), P=1.000). Further postoperative course was uneventful in 179 (98.9%) patients. TULAA can be used as first approach for appendicitis in all children with a low rate of complications. Extracorporeal appendix stump closure can be safely achieved in the majority of children without using laparoscopic disposable devices.

Comparison of Outcomes of Single-Incision Laparoscopic and Open Appendectomy in Management of Uncomplicated and Complicated Appendicitis

Several reports have demonstrated the effectiveness and feasibility of single-incision laparoscopic appendectomy (SILA). We have introduced SILA including transumbilical laparoscopic-assisted appendectomy (TULAA) and pure single-incision laparoscopic appendectomy (PSILA). A total of 124 patients underwent SILA for acute appendicitis in our department. Our consecutive experiences with SILA are reviewed, and its outcomes including medical treatment cost are compared to open appendectomy (OA). In the SILA group, the mean length of the operation was 65.0 min. Five patients required an additional port insertion, and three patients required open conversion. The postoperative hospital stay was significantly shorter (P < 0.01); an abdominal drain was placed in significantly fewer cases (P < 0.01). There were no significant differences in the total cost medical treatment with OA (P = 0.48). In patients with complicated appendicitis, the hospital stay was significantly shorter in SILA groups. There were no significant differences in all operative outcomes between TULAA and PSILA. SILA represents an expeditious and reliable technique for appendicitis especially in complicated cases. Further assessment including multicenter prospective study is thought to be required to confirm this.

Single port laparoscopic repair of sigmoid colon perforation during colonoscopy.

Colonic perforation during colonoscopy is a rare but lethal complication. Recently, it is usually managed with laparoscopic approach. Here we present our experience of single incision laparoscopic repair for sigmoid colon perforation during colonoscopy. A 57-year-old male patient presented with an acute sigmoid colon perforation event during diagnostic colonoscopy. Emergency operation was performed with transumbilical single incision laparoscopic exploration. The perforated site of sigmoid colon was primarily repaired with the curved endoscopic linear stapler. The patient was discharged after 5 days uneventfully. Single port laparoscopic repair is a safe and feasible method for the management of acute colonoscopic perforation during diagnostic colonoscopy.

First 200 consecutive transumbilical single-incision laparoscopic TEPs.

Endoscopic pre-peritoneal mesh repair (TEP) through single-incision laparoscopy (SIL) permits placement of a large mesh through a final millimetric umbilical scar. This prospective study evaluates the first 200 consecutive SILTEPs performed by a single surgeon. Between November 2011 and September 2015, 200 consecutive SILTEPs were performed in 161 patients. The mean age was 49.8±16.3years and the mean BMI was 24.5±3.4kg/m2. The technique involved one 11-mm trocar, one 10-mm 0° scope and curved reusable instruments. A supplementary 1.8-mm straight trocarless grasping forceps was percutaneously inserted for perioperative complications or difficulties. A unilateral hernia repair was performed in 122 patients, and a bilateral repair in 39 patients. The total operative time was 57.4±22.3min, and pure laparoscopic time was 46.6±21.6min. There was no need for insertion of a supplementary 5-mm trocar, and the need for insertion of 1.8-mm trocarless grasper was 32.9%. Perioperative complications occurred in 73 patients. The mean final scar length was 15.3±2.6mm. The mean hospital stay was 1.0±0.3days. Postoperative complications at the access site affected 15 patients and at the hernia site 31 patients. After a mean follow-up of 25.4±12.3months, there was one asymptomatic, small incisional hernia at the access site as well as one reoperation for recurrent inguinal hernia at 16months. No other late complications were registered. Transumbilical SILTEP permits placement of a large mesh through a final millimetric scar. Getting over the learning curve in conventional multitrocar TEP is mandatory. As per our institute's algorithm, the contraindications continue to be giant inguino-scrotal, incarcerated and recurrent inguinal hernias.

Transumbilical Single-Incision Laparoscopic Surgery in Children with Conventional Instruments: Our Early Experience.

Laparoscopic surgery is the current accepted approach in most pediatric surgical centers. In an attempt to further minimize the surgical trauma and improve cosmetic outcome, new techniques with a single incision through the umbilicus have been proposed and we believe they will become the standard choices for pediatric surgery. This report describes our initial experience with transumbilical single-incision laparoscopic surgery (TSILS) in children with conventional instruments. A retrospective review of 82 pediatric patients who underwent TSILS in children with conventional instruments from January 2011 to June 2015 was performed. The operations included 56 appendectomies, 9 cholecystectomies, and 17 spermatic vein ligations. The average age by procedure was 6.2 years for appendectomy (range of 3-14 years); 12.4 years for cholecystectomy (range of 10-14 years); and 12.8 years for spermatic vein ligation (range of 11-14 years). The average operative time was 32 minutes for appendectomy (range of 25-56 minutes); 54 minutes for cholecystectomy (range of 35-95 minutes); and 23 minutes for spermatic vein ligation (range of 17-41 minutes). The average length of staying in hospital was 3 days (range of 2-5 days). All of the operations in 82 cases were successful. None required conversion to open or conventional laparoscopic surgery. There was no obvious wound pain. In addition, there were no wound infections on umbilicus and any other intraoperative complications. There was no obvious scar at patients' umbilicus after postoperative follow-up for 2-4 weeks. TSILS is a safe and viable technique that may be used successfully in pediatric surgery. Additionally, excellent cosmetic results are obtained as evidenced by imperceptible umbilical scarring.

A combination of ultrasound-guided rectus sheath and transversus abdominis plane blocks is superior to either block alone for pain control after gynecological transumbilical single incision laparoscopic surgery

Purpose: To investigate the efficacy of the combination of ultrasound-guided rectus sheath (RS) and transversus abdominis plane (TAP) blocks compared with TAP or RS block alone in gynecological single-incision laparoscopic surgery (SILS). Materials and Methods: Bilateral TAP blocks (Group A, n = 12), TAP and RS blocks (Group B, n = 12), and RS blocks (Group C, n = 12) with 40 ml ropivacaine/ patient were performed for ovarian tumor SILS. The analgesic effects were evaluated using a numerical rating scale (NRS) at zero, six, 12, 24, and 48 hours post-surgery. Results: Umbilical pain on completion of general anesthesia was significantly less frequent in Group B (1/12) than Group A (7/12) (p = 0.03). The postoperative NRS scores were significantly lower in Group B than Group A at zero (p = 0.02) and six (p = 0.03) hours and Group C at zero (p = 0.001), six (p = 0.02), and 12 (p = 0.004) hours. Conclusion: The combination of RS and TAP blocks reduced early postoperative pain compared with RS or TAP block alone for gynecological SILS.

Transumbilical single-incision laparoscopic vaginoplasty hybrid transperineal approach using a sigmoid colon segment: initial twenty-five cases.

To validate the technical feasibility and anatomical and functional outcomes of transumbilical single-incision laparoscopic (SIL) sigmoid vaginoplasty hybrid transperineal approach in women with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. Twenty-five patients who underwent transumbilical SIL sigmoid vaginoplasty hybrid transperineal approach were retrospectively evaluated. Operation time and postoperative complications were analyzed. The length and breadth of the neovagina, lubrication and the Female Sexual Function Index were evaluated to assess the anatomical and functional outcomes of the surgery. All the cases were successfully performed without any intraoperative morbidity. The mean operative time and postoperative hospital stay were 162±38min and 11±3days, respectively. The postoperative complications included one case of a stress ulcer, one case of a neovaginal ulcer and two cases of umbilical incision infection. Sixteen women had regular intercourse and were satisfied with both the surgical outcome and subsequent sexual activity. Transumbilical SIL sigmoid vaginoplasty hybrid transperineal approach offers a feasible scarless method with cosmetic advantage for women with MRKH syndrome to establish new functional vagina.

Minimal Invasive Internal Liver Retractor in Conventional and Trans-umbilical Single-Incision Laparoscopic Sleeve Gastrectomy: Video Report

Sleeve gastrectomy (SG) is a safe and efficient procedure with comparable results between conventional and single-incision approach in selected patients. However, the critical point in both approaches is the retraction of the hypertrophic and fatty left lobe of the liver which increases technical difficulties and limit the exposure of the hiatus. Traditional liver retractors require an additional sub-xiphoid incision for insertion and cause post-operative pain as well as iatrogenic liver injuries. Various techniques have been described to allow adequate liver retraction through smaller incisions or fewer ports without compromising patient safety. However, some disadvantages of these methods are the need for incision of the liver ligament or diaphragmatic crura puncture rendering the device difficult to reposition. Two morbidly obese patients underwent a SG by conventional laparoscopy and by trans-umbilical single-incision using a novel minimal invasive internal liver retractor: the Versa Lifter Band®. This soft and flexible internal retractor was fully repositionable and adjustable intraoperatively. The time required to complete the liver retraction was 4 min 12 s in conventional surgery and 5 min 23 s in single-incision approach. Liver retraction was always satisfying resulting in limited intra-operative difficulties without the need of additional retractors/ports or conversion in both patients. No adverse outcomes occurred during the intra and post-operative periods without rise in aspartate aminotransferase and alanine-aminotransferase serum levels. In our preliminary experience, this internal liver retractor was easy to handle and provided an effective and safe retraction with good exposure of the surgical field and improved ergonomy in single incision as well as reduced port laparoscopic SG.

A comparative study between single incision laparoscopic appendectomy and conventional laparoscopic appendectomy

Background: Until recently transumbilical single incision laparoscopic appendectomy has been less popular in clinical practice than traditional laparoscopic appendectomy (LA). The goal of our study was to conduct a comparative analysis of the clinical outcomes for conventional laparoscopic appendectomy (CLA) and transumbilical single incision laparoscopic appendectomy (SILS). Methods: This prospective study SILS versus CLA was carried out in the postgraduate department of surgery GMC Srinagar from February 2013 to October 2014 on patients suspected of having acute appendicitis. All patients were worked up and assessed according to a predefined protocol-detailed history, complete clinical examination, and laboratory parameters. Results: The mean age of the patients in the SILS group was 23.9 years (16-35 years) and that in the CLA group was 25.3 years (16-35 years) (p>0.05). The mean operating time in the SILS group was 57.66 minutes and in the CLA group 52.83 minutes (p>0.05). The difference in the postoperative pain score of the two groups was not statistically significant (p>0.05). In our study cosmesis was assessed by using Manchester scar scale. The mean cosmesis scores were: 7 th POD 6.0±0.587 (SILS) and 6.9±0.922 (CLA); 3 months postoperatively 5.73±0.691 (SILS) and 6.56±1.072 (CLA); 6 months postoperatively 5.33±0.606 (SILS) and 6.23±1.104 (CLA). The difference in mean cosmesis score between SILS and CLA was statistically significant (p<0.05). Conclusions: Our comparative study between single incision laparoscopic appendectomy and conventional laparoscopic appendectomy shows that besides better cosmetic results in the former, there are no added advantages. However, SILS can be a safe and feasible alternative in young females who are cosmesis-conscious.

Endoscopically Assisted Transumbilical Single-Incision Laparoscopic Gastric Resection for GIST Treatment

ABSTRACTPurpose: Complete surgical resection with negative margins without lymphadenectomy is the treatment of choice for nonmetastatic Gastrointestinal Stromal Tumors (GISTs). Laparoscopic resection of gastric GISTs <5 cm is an acceptable and oncologically feasible, safe, and effective treatment. We present our experience of an endoscopically assisted minimally invasive transumbilical single-incision laparoscopic (SILS) technique for gastric GISTs resection. Methods: Four patients with small gastric GISTs ≤5 cm located on the greater curvature or the anterior wall were resected with SILS by using a lesion-lifting technique under the guidance of flexible gastroscopy. Results: The technique was feasible and safe and offered significant advantages in locating the tumor and controlling the resection margins. There were no major intraoperative or postoperative complications, conversions, or tumor ruptures. Pathology showed low-risk GISTs resected with disease-free margins without tumor rupture. No recurrences have been observed. Conclusion: The endoscopically assisted SILS wedge gastrectomy is a feasible, safe, and advantageous technique for the treatment of the greater curvature or anterior wall gastric GISTs.

Transumbilical single incision laparoscopic sleeve gastrectomy (with video)

Transumbilical single incision laparoscopic sleeve gastrectomy (with video)

Success of Minimally Invasive Transumbilical Single-Incision Laparoscopic Surgery (T-SILS) Plus Double-Balloon Endoscopy (DBE) for Pediatric Intestinal Angiodysplasia: A Case Report

We describe here a child with angiodysplasia of the small intestine, diagnosed by double-balloon endoscopy (DBE), who was treated with transumbilical single-incision laparoscopic surgery (T-SILS). A 9-year-old boy presented to another hospital with intermittent fresh melena of a duration of 5 months and 4 days. Anoscopy and gastric mucosal membrane scintigraphy were unsuccessful diagnostically, and he was referred to our hospital for further examination and treatment. Under general anesthesia, we performed DBE by an anal route, with the ileum assessed for a distance of about 150 cm from the ileocecal valve. Although no bleeding lesion was found in the colon, a flat elevated venous lake approximately 20 mm in size was observed 20 cm from the ileocecal valve, suggesting angiodysplasia of the small intestine. A tattoo was made under DBE, and wedge resection by T-SILS was performed 1 month later under general anesthesia. The excised specimen appeared as a flat, elevated venous lake approximately 20 mm in size. Histopathologic analysis revealed several dilated and distorted veins within the submucosa of the small intestine. The patient was diagnosed with angiodysplasia of the small intestine. His postoperative course was uneventful, and he remained free of recurrent gastrointestinal bleeding 18 months after the operation. This is the first case report showing the diagnosis, localization, and tattooing of an obscure gastrointestinal bleeding lesion of the small intestine by preoperative DBE and removal of the lesion by subsequent T-SILS in children.

Dešiniosios hemikolektomijos vieno pjūvio laparoskopinė operacija: dviejų atvejų aprašymas

Vieno pjūvio chirurginės procedūros vystosi kaip minimaliai invazinės chirurgijos dalis. Dešinioji hemikolektomija, atlikta SILS būdu, pirmą kartą aprašyta 2008 metais. Mes aprašome pirmąsias dvi laparoskopines transumbilikalines vieno pjūvio dešiniąsias hemikolektomijas, atliktas Vilniaus universiteto ligoninėje Santariškių klinikos.

Effectiveness of ultrasound-guided transversus abdominis plane block and rectus sheath block in pain control and recovery after gynecological transumbilical single-incision laparoscopic surgery

Purpose: To evaluate the effectiveness of ultrasound-guided transversus abdominis plane (TAP) and rectus sheath (RS) blocks in pain management and recovery after gynecological single-incision laparoscopic surgery (SILS). Materials and Methods: Abilateral TAP block (Group A, n=9), bilateral TAP and RS blocks (Group B, n=10), and a bilateral RS block (Group C, n=9) with 40 ml ropivacaine per patient were conducted in 28 patients undergoing SILS for ovarian tumors. A pain score and walking distance in a 6-minute walk test (6MWT) were examined. Results: Pain scores were significantly lower on postoperative day (POD) 3 than on POD 1 in Groups B (p = 0.03) and C (p = 0.02). The walking distance on POD 3 was comparable with that before surgery in Group C (p = 0.75), but shorter in Groups A (p = 0.004) and B (p = 0.02). Conclusions: The RS block alone was the most effective in relieving pain and accelerating general recovery after gynecological SILS.

Single-incision laparoscopic splenectomy with conventional instruments: preliminary experience in consecutive patients and comparison to standard multiple-incision laparoscopic splenectomy.

To study the feasibility and efficiency of transumbilical single-incision laparoscopic surgery splenectomy (SILS-Sp) using conventional instruments in consecutive patients and to compare outcomes of the procedure with those of standard multiple-incision laparoscopic splenectomy (MLS). A retrospective review was conducted to evaluate all SILS-Sp procedures performed by a single surgeon between March 2010 and January 2013. Additionally, patients who underwent MLS by other surgeons in the same surgical group during the same period were evaluated to serve as a control group. Demographic data, operative parameters, and postoperative outcomes were assessed. Thirteen patients underwent successful SILS-Sp during the study period without conversion to an open procedure or requiring additional ports. The median operative time was 165 minutes. There was 7.7% morbidity and no mortality in the study group. Median length of stay was 8.8 days. Additionally, 12 patients who underwent MLS were evaluated for comparison. No significant differences were identified in the preoperative patient characteristics between the two groups. For MLS, the median operative time was 158 minutes. There was 8.3% morbidity and no mortality in the group. Median length of stay was 8.3 days. SILS-Sp using conventional instruments was associated with reduced postoperative pain scores, but this did not reach statistical significance. The operative time, conversion rate, and length of stay were equivalent. The mortality, morbidity, and cost were also similar in the two groups. The umbilical incision of the single-incision group can be easily hidden in the umbilical fold with ideal cosmetic result. SILS-Sp is feasible and efficient in an unselected patient population in the hands of an experienced laparoscopic surgeon. The single-incision technique is comparable to standard laparoscopic splenectomy in terms of operative time and perioperative outcomes. Ideal cosmetic effect may be its potential advantage.

Transumbilical single-incision laparoscopic subtotal gastrectomy and total intracorporeal reconstruction of the digestive tract in the treatment of benign peptic ulcers

BackgroundSingle-incision laparoscopic surgery is being applied increasingly in many surgical specialties. However, few reports are available regarding its use in the treatment of benign peptic ulcer disease. MethodsWe report here on nine patients with gastric or duodenal ulcers who underwent transumbilical single-incision laparoscopic subtotal gastrectomy (SILSG) between November 2010 and June 2013. All procedures were performed with conventional laparoscopic instruments placed through a single operating portal of entry created within the umbilicus. Total intracorporeal gastrojejunostomy or gastroduodenostomy was then performed for reconstruction of the digestive tract. ResultsOnly one case required conversion from single-incision to multiple-incision surgery. Among the eight patients who successfully underwent SILSG, total intracorporeal gastroduodenostomy was performed in two and gastrojejunostomy in six. The mean operation time was 290 ± 50 min (range 230–360 min), and blood loss was 200 ± 66 mL (range 100–300 mL). The patients recovered fully, and the single umbilical scars healed well. ConclusionsWe believe this is the first report of SILSG with total intracorporeal gastrojejunostomy or gastroduodenostomy in the treatment of benign peptic ulcers. On the basis of this initial experience, SILSG for this indication in the hands of experienced surgeons appears to be feasible and safe.

Pure transumbilical SILS gastric bypass with mechanical circular gastrojejunal anastomosis feasibility.

Since Wittgrove introduced the laparoscopic version of the gastric bypass in 1994, the interest still remains in the decrease of the abdominal wall trauma in order to optimize the benefits of laparoscopy on postoperative pain, cosmesis, hospital stay, and convalescence in bariatric patients. This work is to report the feasibility of gastric bypass surgery by a pure transumbilical single-incision laparoscopic surgery (SILS) with a mechanical circular gastrojejunal anastomosis. Thirty-four patients (10 males and 24 females) were offered to receive gastric bypass with circular mechanical gastrojejunal anastomosis by Single Incision Laparoscopic Surgery (SILS) using pure transumbilical access. Anastomotic leak occurrence was the primary end-point. Patients demographics, operative time, additional trocarts, hemorrhage, intra abdominal abscess, length of post-operative stay, readmission, 30 days death, gastrojejunal anastomosis stricture, marginal ulcers, reflux complains, seromas, incisional hernias, and % excess BMI loss were also recorded in a prospective database. Primary end-point showed no anastomotic leak occurrence during the hospital stay or during the first 30 post-operative days. SILS gastric bypass with a circular mechanical gastrojejunal anastomosis is feasible and seems to be safe.

Laparoscopic Vaginoplasty Using a Sigmoid Graft Through the Umbilical Single-Incision Hybrid Transperineal Approach: Our Initial Experience

For better cosmetic appearance, attempts to reduce the number of laparoscopic wounds have been sought. Investigators have thus begun to carry out procedures through a single incision or natural orifice endoscopic surgery instead of using conventional laparoscopic surgery. The authors here describe transumbilical single-incision hybrid transperineal laparoscopic surgery as a novel approach for vaginoplasty using a sigmoid graft. From August 2010 to October 2012, 15 young females with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome underwent laparoscopic sigmoid vaginosplasty using a combined transumbilical single-incision and transperineal approach. A multichannel single port was placed through the umbilical incision for the main laparoscopic procedures. A 12-mm trocar as an assisting working port was inserted into the pelvic cavity through the transvaginal dimple between the rectum and urethra. A functioning vagina 12-15 cm in length and approximately 4 cm in width was created in all the patients. The average operative time and hospital stay were 151.5±34.2 minutes and 7.4±3.2 days, respectively. The only perioperative complications were 1 case of stress ulcer and 1 case with umbilical infection. All patients were satisfied with the surgery, and 12 of them had subsequent sexual activity. Transumbilical single-incision hybrid transperineal laparoscopic sigmoid vaginoplasty offers a feasible scarless approach for females with MRKH syndrome. The favorable cosmetic results would favor use of this type of vaginoplasty as an alternative to the conventional laparoscopic approach.