Evaluation of Laparoendoscopic Single-site Gynecologic Surgery with a Multitrocar Access System

Ichikawa, Masao; Akira, Shigeo; Mine, Katuya; Ohuchi, Nozomi; Iwasaki, Nao; Kurose, Kouichi; Takeshita, Toshiyuki

doi:10.1272/jnms.78.235

Cited by 14 publications

(13 citation statements)

References 12 publications

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“…The initial search yielded 668 unique references, and twenty-three studies fulfilled our inclusion criteria. Eleven studies compared LESS hysterectomy to conventional TLH [13, 20–29], eleven studies compared LESS hysterectomy to LAVH [30–40], and in one study, both procedures were included [41]. Two studies also included supra-cervical hysterectomies [20, 21].…”

Section: Resultsmentioning

confidence: 99%

“…A total of 1985 women in the LESS group and 2466 women in the conventional hysterectomy were included in six randomized controlled trials [23, 24, 26, 30, 39, 41], five prospective cohort studies [21, 27, 32, 36, 37], and 12 retrospective cohort studies [13, 20, 22, 25, 28, 29, 31, 33–35, 38, 40]. Twenty of the studies (86.9%) were performed in Asia (fifteen in Korea [13, 23–25, 27, 28, 31, 32, 34–39, 41], one in China [26], two in Japan [29, 40], and two in Taiwan [30, 33]), and the other three studies originated from the United States [20], Italy [22], and France [21]. Fourteen studies had a single center design [20–24, 26–30, 33, 36, 37, 39], one RCT was multi-center, and in the other eight studies, the setting was unclear [13, 25, 31, 32, 34, 35, 38, 40].…”

Section: Resultsmentioning

confidence: 99%

“…Fifteen studies stated that there was no potential conflict of interest to disclose [13, 20–27, 30–33, 35, 38], five studies reported financial support (from a grant of Samsung Medical Center [39], from a grant of Korea Health Care technology [36, 37], from Covidien [41], and from Kyung Hee University Research Fund [34]), and three studies remained unclear about their potential conflicts [28, 29, 40]. …”

Section: Resultsmentioning

confidence: 99%

“…In the study by Bush et al patients were asked their aesthetic preference regarding scars, and no differences were observed between the single-site and conventional incisions [6]. In LESS surgery, higher forces are applied on the umbilical port during tissue handling and irreversible umbilical deformation has been described [29]. It is also suggested that LESS would lead to a higher risk of port herniation as the opening of the umbilical port is larger [49–51].…”

Section: Discussionmentioning

confidence: 99%

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Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta-analysis

Sandberg

Chapelle

Tweel

et al. 2017

Arch Gynecol Obstet

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PurposeTo assess the safety and effectiveness of LESS compared to conventional hysterectomy.MethodsThe systematic review and meta-analysis was performed according to the MOOSE guideline, and quality of evidence was assessed using GRADE. Different databases were searched up to 4th of August 2016. Randomized controlled trials and cohort studies comparing LESS to the conventional laparoscopic hysterectomy were considered for inclusion.ResultsOf the 668 unique articles, 23 were found relevant. We investigated safety by analyzing the complication rate and found no significant differences between both groups [OR 0.94 (0.61, 1.44), I 2 = 19%]. We assessed effectiveness by analyzing conversion risk, postoperative pain, and patient satisfaction. For conversion rates to laparotomy, no differences were identified [OR 1.60 (0.40, 6.38), I 2 = 45%]. In 3.5% of the cases in the LESS group, an additional port was needed during LESS. For postoperative pain scores and patient satisfaction, some of the included studies reported favorable results for LESS, but the clinical relevance was non-significant. Concerning secondary outcomes, only a difference in operative time was found in favor of the conventional group [MD 11.3 min (5.45–17.17), I 2 = 89%]. The quality of evidence for our primary outcomes was low or very low due to the study designs and lack of power for the specified outcomes. Therefore, caution is urged when interpreting the results.ConclusionThe single-port technique for benign hysterectomy is feasible, safe, and equally effective compared to the conventional technique. No clinically relevant advantages were identified, and as no data on cost effectiveness are available, there are currently not enough valid arguments to broadly implement LESS for hysterectomy.Electronic supplementary materialThe online version of this article (doi:10.1007/s00404-017-4323-y) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta-analysis

Sandberg

Chapelle

Tweel

et al. 2017

Arch Gynecol Obstet

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“…Due to instrumental angulation, surgeons may encounter difficulty with suturing, requiring a greater level of surgical expertise. One significant finding has been the extended operation time performing LESSH [4,9]. However, studies show that with increasing operator experience, operative time can be reduced [1,4].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of laparoendoscopic single-site surgery in supracervical hysterectomy: technique and retrospective case-control comparison

2015

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One recent innovation in the field of gynecology is laparoendoscopic single-site surgery (LESS). It is associated with reduced postoperative pain and better cosmetic outcome. The present paper aims to explain techniques and instrumentations associated with single-port hysterectomies. A retrospective case-control study is included, comparing LESS with conventional four-port hysterectomies to highlight the feasibility of LESS. This study involved literature search and personal experience regarding single-port hysterectomy and a retrospective case-control study of 34 patients who underwent supracervical hysterectomy between April 2011 and November 2012. Operating time, blood loss, and length of hospital stay were similar in the two groups. Patient's evaluation of the cosmetic result was in favor of LESS, however not significant. LESS represents a new frontier in minimally invasive surgery. New instrumentation and recommendations have been developed which are expected to make the technique more feasible. This study demonstrates that LESS supracervical hysterectomy has comparable operative outcomes to conventional laparoscopic hysterectomy and is a feasible approach for supracervical hysterectomy. Based on the literature and our experience, a feasible step by step technique for surgeons who are interested in performing supracervical LESS hysterectomy is described. Comparative data and prospective trials are required in order to determine the clinical utility and impact of LESS in treatment of gynecological conditions in the future.

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Single-port laparoscopic surgery in gynecology—current status

Kondo

Ribeiro²,

Zomer

2012

Gynecol Surg

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The objective of this study is to report the current status on single-port laparoscopic surgery in gynecology. A systematic MEDLINE review of the English language literature from 2007 to 2011 was performed using the search term "single-port surgery," which contained information on single-port laparoscopic surgery in gynecology. Overall, 1,152 patients (26 studies) were included in the analysis. The operative time varied according to the type of procedure. The conversion rate to conventional laparoscopy was 1.99 %, and the conversion rate to laparotomy was 0.35 %. Postoperative complications were encountered in 1.48 % of cases. Different gynecologic procedures have been effectively performed by means of single-port laparoscopic surgery. The procedure seems to be feasible, reproducible, and safe. Reduced pain and improved cosmesis are supposed to be the potential advantages of these procedures, but it was not completely confirmed yet! Further studies are still necessary to establish the real benefits of this new surgical approach over the traditional multi-port laparoscopy.

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Evaluation of Laparoendoscopic Single-site Gynecologic Surgery with a Multitrocar Access System

Cited by 14 publications

References 12 publications

Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta-analysis

Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta-analysis

Feasibility of laparoendoscopic single-site surgery in supracervical hysterectomy: technique and retrospective case-control comparison

Single-port laparoscopic surgery in gynecology—current status

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