Laparoendoscopic Single Site Hysterectomy: Literature Review and Procedure Description

Abstract

Laparoendoscopic single site surgery (LESS) refers to a spectrum of surgical techniques that allow the performance of laparoscopic surgery through consolidation of all ports into one surgical incision. LESS has emerged as a potentially less invasive alternative to multiport laparoscopy and in the last year in gynecology; hence, this approach has been largely applied for selective indications to perform total hysterectomy. We performed a literature review on single site hysterectomy and described indications and technique, highlighting practical problems, pointers, limitations and recent technical development as robotic assistance.

Comparison between Robotic Single-Site and Laparoendoscopic Single-Site Hysterectomy: Multicentric Analysis of Surgical Outcomes

“…Because the intraoperative adverse events necessitated an intracorporal bladder suture, conversion to laparotomy was more common for the robotic than the laparoscopic technique in our study. In the meta-analysis performed by Mereu et al [ 26 ], the risk of the single-site laparoscopic conversion technique during hysterectomy was comparable to that of the multiport technique. The LESSH group had more postoperative adverse events than the RSSH group, but the total and operative time were longer in the RSSH group, because the most important limitation of this study was the different surgical skills represented without randomised enrolment.…”

A retrospective analysis of robot-assisted total hysterectomy by transvaginal natural orifice transluminal endoscopic surgery

“…Over the past three decades, there have been remarkable advancements in surgical techniques. Traditional open surgery has been rapidly replaced by minimally invasive approaches such as laparoscopy, robot-assisted laparoscopic surgery, SPLS, and transvaginal SPLS [ [14] , [15] , [16] ]. Concurrently, perioperative management has gradually shifted from conventional models to the concept of accelerated rehabilitation surgery.…”

Cirugía laparoscópica por puerto único (LESS) en ginecología oncológica: experiencia en el Instituto Nacional de Cancerología, Bogotá, D.C., Colombia

“…Esta técnica, que se traduce en un mejor resultado estético para los pacientes, ha demostrado además generar un período de incapacidad más corto, rápida recuperación y disminución de los requisitos de analgesia postoperatoria en comparación con los pacientes tratados con abordajes laparoscópicos convencionales (1)(2)(3)(4). También, al tener una incisión más extensa, se facilita extraer piezas quirúrgicas más grandes sin ampliarla y permite realizar nuevamente insuflación de C02 si así se requiere (1).…”

“…Los datos publicados en la literatura actual, en las área ginecología y ginecología oncológica, han demostrado la factibilidad técnica y la reproducibilidad de esta cirugía cuando se utiliza para una variedad de procedimientos que incluyen la histerectomía total, salpingooforectomía reductora de riesgo, resección de tumores de ovario y pélvicos y procedimientos más complejos como la histerectomía radical y la linfadenectomía pélvica (2,4,5).…”