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

Abstract

Single-port access total laparoscopic hysterectomy (SPA-TLH) could be associated with less pain, faster recovery, and improved cosmetic results when compared with conventional laparoscopic procedures [1]. However, operative experience for SPA-TLH is currently limited, and intracorporeal suturing for vaginal repair remains a challenge [2]. The V-Loc suture (Covidien, Mansfield, MA, USA) is a unidirectional barbed suture with shallow barbs distributed circumferentially, simplifying laparoscopic suturing [3]. The aim of the present study was to evaluate the feasibility and safety of SPA-TLH using advanced laparoscopic devices and unidirectional barbed sutures when conducting vaginal vault closure.Patients with benign uterine diseases and no comorbidities who underwent SPA-TLH procedures at the Beijing Union Medical College Hospital between March 1 and August 31, 2013, were eligible for inclusion. The study was approved by the hospital ethics committee, and participants provided informed consent. All procedures were performed via single umbilical cord incisions using conventional laparoscopic instruments and the following techniques: 1) a multichannel port with at least one 12-mm trocar to allow portswitching; 2) multifunction energy instruments for coagulation and dissection (including the LigaSure system [Covidien, Mansfield, MA, USA]); 3) curved instruments together with standard straight instruments to avoid clashing; and 4) an electronic videoscope to provide all-angle views. Following uterine specimen removal, the vaginal cuff was closed using straight acutenaculum with V-Loc sutures (Fig. 1), which made vaginal vault closure through the single incision port.Overall, 23 patients were included. The mean age was 44 years (range 41-59). The mean excised uterus weight was 203 g (range 100-295) and the mean operative time from incision to closure was 73 min (range 40-95). Mean total hospital stay was 2.4 days (range 2-4) and mean intraoperative blood loss was 99 mL (range 50-200). Postoperative pain reported 24-72 hours after the SPA-TLH procedure was minimal (mean visual analog scale score was 3.9 [range 2-6]) and all patients resumed normal activities within 7 days of surgery. Fig. 1. Laparoscopic vaginal vault closure using unidirectional barbed suture. (a) Initiation of the vaginal cuff closure. When initiating the suture at one end of the vaginal cuff, the unidirectional barbed suture was inserted through the loop after the needle took the first bite. (b) Completion of the vaginal cuff closure. After continuous running suture, the vaginal vault was closed. The end of the suture was cut; a knot was not required. http://dx.

Hysterectomy and bilateral adnexectomy using transvaginal natural orifice transluminal endoscopic surgery: The role of multichannel abdominal PORT and vaginal support ring

“…In lieu with the aforementioned concerns, we have independently and successfully developed a five‐channel port which has been applied for patents. After successful use of single ports for transumbilical laparoscopic surgery, 21–23 for the first time, we have used this five‐channel port for transvaginal NOTES, which solves the problem of fixation and use of multiple laparoscopic instruments simultaneously (Figure 3). Additionally, considering the structure of vagina in term of length and thickness, the contraction of vaginal wall makes them less compatible between the wall of vagina and protective sheath.…”