Percutaneous-Assisted versus Laparoscopic Hysterectomy: A Prospective Comparison

Abstract

Objective: To evaluate the feasibility of percutaneous approach, we prospectively compared our experience in percutaneous-assisted hysterectomy (PSS-H) with that in a series of laparoscopic hysterectomies (LPS-Hs). Methods: In this multicentric cohort study, from May 2015 to October 2017, 160 patients affected by benign and malignant gynecological conditions were considered eligible for minimally invasive surgery (MIS): 80 patients received PSS-H and 80 LPS-H. In each group, 30 cases of low-/intermediate-risk endometrial cancer were enrolled. For both groups, we documented preoperative outcomes, postoperative pain, and cosmetic outcomes. Results: No statistically significant differences were noted in baseline characteristics or operative time. We observed significant differences in estimated blood loss: median of 50 cc (PSS-H) and 100 cc (LPS-H) (p = 0.0001). In LPS-H, we reported 4 (5.0%) intraoperative complications and 1 (1.3%) in PSS-H. Thirty-day complications were 4 (5%) in PSS-H and 11 (13.8%) in LPS-H (p = 0.058). No significative differences were found in visual analog scale score, despite a relevant disparity in cosmetic outcome (p = 0.0001). For oncological cases, the 2 techniques had comparable intraand postoperative outcomes and oncological accuracy. Conclusions: In this study, we reported that PSS-H is comparable to LPS-H for intra-and perioperative outcomes and postoperative pain, while PSS-H seems to be superior in cosmetic outcomes and patient satisfaction. PSS-H may represent a valid alternative in ultra-MIS for benign gynecological conditions and low-/intermediate-risk endometrial cancer.

A Multicentric Randomized Trial to Evaluate the ROle of Uterine MANipulator on Laparoscopic/Robotic HYsterectomy for the Treatment of Early-Stage Endometrial Cancer: The ROMANHY Trial

“…The use of the intrauterine manipulator (IUM) has been considered for years as an important assistance in exposing the superficial and retroperitoneal anatomy during laparoscopic and robotic hysterectomies (9). In theory, this device is associated with shortening of the learning curve of standard laparoscopic hysterectomy (31), and it should be an aid to move minimal invasiveness beyond the standard laparoscopy in the ultra-minimally invasive field (32)(33)(34)(35). Contrary to what was expected, our results showed a shorter operative time in the procedures carried out without IUM, particularly for laparoscopic procedure.…”

Ultra-minimally invasive surgery in gynecological patients: a review of the literature

“…Overlapping results were also shown by Perrone et al [ 73 ] in a multicentric cohort study comparing percutaneous with “classical laparoscopic surgery”.…”

Transvaginal natural orifice endoscopic surgery for ovarian cystectomy: a more suitable surgical approach for the day-care procedure

“…With the development of medical devices and the popularization of minimally invasive concepts, patients prefer surgeries that offer better esthetic outcomes, including those that inflict no or smaller scar ( 8 , 9 ), such as needleoscopic and percutaneous-assisted surgery ( 10 , 11 ). Currently, the minimally invasive approaches for ovarian cystectomy are vaginal natural orifice transluminal endoscopic surgery (vNOTES) and transumbilical laparoendoscopic single-site surgery (TU-LESS) ( 12 , 13 ).…”