Review and meta-analysis of prospective randomized controlled trials (RCTs) comparing laparo-endoscopic single site and multiport laparoscopy in gynecologic operative procedures

Pontis, Alessandro; Sedda, Franciscu; Mereu, Liliana; Podda, Mauro; Melis, Gian Benedetto; Pisanu, Adolfo; Angioni, Stefano

doi:10.1007/s00404-016-4108-8

Cited by 36 publications

(27 citation statements)

References 37 publications

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“…In the LESS approach, no additional port was needed. In other trials, a frequency of 3.5% to additional port was denoted [17]. Our results demonstrated that LESS hysterectomy was comparable to conventional laparoscopic hysterectomy, mainly depending on the experience of the surgeon.…”

Section: Discussionmentioning

confidence: 51%

Comparison of laparoscopy-assisted vaginal hysterectomy as endoscopic single-station surgery and conventional laparoscopic hysterectomy—surgical effects on safety and quality of life

et al. 2019

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Background: To extend the benefits of minimally invasive surgery, an increasing enthusiasm has emerged for the laparo-endoscopic single-site surgery (LESS). The idea of LESS is to allow inserting multiple laparoscopic instruments through only one umbilical incision instead of multiple abdominal incisions. Methods: Sixty patients from three different centers in Germany were randomized (1:1) to conventional laparoscopic hysterectomy (n = 31) or LESS hysterectomy (n = 29). The study focused in particular on the safety and efficacy of both techniques. Results: The mean operative time was comparable in both groups (68.2 vs 73.6 min., p = 0.409; 95% CI − 18.69-7.12). No differences were seen regarding estimated blood loss (p = 0.915; 95% CI − 21.02-18.88), intra-and postoperative complications (p = 0.944), and wound infection rates (p = 0.944). Patients within the LESS group experienced significantly less pain in the first 24 h postoperatively (p = 0.006); the pain scores at 3, 5, 7 days and 2 months postoperatively were comparable. Conclusion: LESS hysterectomy is a reliable and safe option in gynecologic surgery. Compared to conventional laparoscopic hysterectomy, LESS surgery demonstrated comparable surgical properties in regard to blood loss, duration of surgery, and intra-/postoperative complications. Notably, patients undergoing LESS hysterectomy experienced some less pain postoperatively.

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Section: Discussionmentioning

confidence: 51%

Comparison of laparoscopy-assisted vaginal hysterectomy as endoscopic single-station surgery and conventional laparoscopic hysterectomy—surgical effects on safety and quality of life

et al. 2019

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“…Since LESS requires only a single incision in the umbilicus, some authors advocate that it is associated with a better cosmetic outcome compared with conventional laparoscopy [12, 24, 25]. We were unable to evaluate this variable among the selected studies since this information was not reported.…”

Section: Discussionmentioning

confidence: 79%

“…However, only recently it has gained popularity and has been adopted in several fields including gynecology [12]. This is mainly related to the advances in technological innovation with the introduction of multi-channel single port systems and articulating instruments.…”

Section: Introductionmentioning

confidence: 99%

Conventional versus Single Port Laparoscopy for the Surgical Treatment of Ectopic Pregnancy: A Meta-Analysis

Gasparri¹,

Mueller²,

Taghavi³

et al. 2018

Gynecol Obstet Invest

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Background/Aims: A new minimally invasive laparoscopic approach for ectopic pregnancy, the laparo-endoscopic single site surgery (LESS), has recently been introduced. The aim of this study is to compare the surgical outcome of this approach with conventional laparoscopy for ectopic pregnancy. Method: A review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement was performed. Electronic databases PubMed, MEDLINE, and Scopus were searched in December 2017 by searching the terms “single port laparoscopy” or “laparoendoscopic single site-surgery” or “single site laparoscopy” or “single-incision laparoscopic surgery” and “ectopic pregnancy.” Studies comparing the 2 techniques and reporting surgical outcome were selected. Endpoints included comparison of length of operative time (OT), hemoglobin drop, length of hospitalization, number of patients requiring packed red blood cells (PRBC) transfusion, intra- and post-operative complication rates between patients undergoing conventional laparoscopy and those undergoing LESS. Results: A total of 56 studies were retrieved of which 5 studies including 460 patients met selection criteria. No differences were found between conventional laparoscopy and LESS with regards to length of OT time (even after stratification for presence of hemoperitoneum and/or adhesions), length of hospitalization, mean hemoglobin drop, number of patients requiring transfusions of PRBC, and intra- and post-operative complications. Conclusion: The management of ectopic pregnancies with LESS does not seem to be superior to conventional laparoscopy.

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“…If the flexible scope is to be used, the tip of the scope can be adjusted to the center of the surgical field without moving the straight segment to provide adequate triangulation and avoid clashing with the surgeon's instruments. 19 Left pelvic side wall adhesions were be released from the lateral pelvic wall using flexible or conventional laparoscopic shears (Cambridge Endo, Framingham, MA), which help to improve the surgical range of motion to reach extreme angles in the pelvis. 20 We then grasped the tubes and ovaries, brought them through the multichannel port after detaching all the trocars from the abdomen.…”

Section: Methodsmentioning

confidence: 99%

“…The left ureter can be more difficult to find because it is often covered by the base of the sigmoid mesocolon. 19 Many time anatomic landmarks are distorted by adhesions endometriosis, or prior surgical exploration. In those cases dissection started from the most normal area and then it should proceed toward the more distorted parts of the operative field.…”

Section: Methodsmentioning

confidence: 99%

Laparo-endoscopic single site (LESS) versus multi-port operative laparoscopy for benign adnexal masses

Kamel¹,

Abbas²,

Salman³

et al. 2018

OGIJ

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Objective:The aim of the current study was to compare the use of the single port laparoscopy versus the use of the conventional multiport laparoscopy in the management of benign adnexal diseases. The study included 60 cases: 40 of them by the conventional multiport laparoscopy, 20 of them by the single port laparoscopy with a confidence interval 95% and power 80%.Study outcomes included the mean duration of surgery, the amount of blood loss and need for blood transfusion, the mean total IM analgesia, the mean total numbers of doses of oral analgesics, the recovery duration, the mean time from surgery to unassisted ambulation, the mean post-operative hospital stay, the mean time to return to sexual activity and finally the overall satisfaction score from the procedure.

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Review and meta-analysis of prospective randomized controlled trials (RCTs) comparing laparo-endoscopic single site and multiport laparoscopy in gynecologic operative procedures

Abstract: LESS may be considered an alternative to MPL with comparable feasibility and safety in gynecologic operative procedures. However, it does not offer the expected advantages in terms of postoperative pain and cosmetic satisfaction.

Cited by 36 publications

References 37 publications

Comparison of laparoscopy-assisted vaginal hysterectomy as endoscopic single-station surgery and conventional laparoscopic hysterectomy—surgical effects on safety and quality of life

Comparison of laparoscopy-assisted vaginal hysterectomy as endoscopic single-station surgery and conventional laparoscopic hysterectomy—surgical effects on safety and quality of life

Conventional versus Single Port Laparoscopy for the Surgical Treatment of Ectopic Pregnancy: A Meta-Analysis

Laparo-endoscopic single site (LESS) versus multi-port operative laparoscopy for benign adnexal masses

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