Single-Port Access Total Laparoscopic Hysterectomy for Large Uterus

Song, Taejong; Lee, Yoonjung; Kim, Miseon; Yoon, Bo Sung; Joo, Won Duk; Seong, Seok Ju; Kim, In Hyun

doi:10.1159/000341141

Cited by 18 publications

(12 citation statements)

References 33 publications

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“…SPA‐TLH has previously been shown safe and feasible [4]. The present study provides further evidence of the safety and feasibility of this procedure, which can be facilitated by unidirectional barbed sutures.…”

supporting

confidence: 62%

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

Zhang

Sun

Lang

2015

International Journal of Gynecology & Obstetrics

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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.

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supporting

confidence: 62%

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

Zhang

Sun

Lang

2015

International Journal of Gynecology & Obstetrics

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“…The median operative time, uterine weight, and EBL were 110 (65-165) min, 600 (502-980) g, and 200 (100-800) ml, respectively. These studies demonstrated that operative time and EBL increased with the growth of uterine weight (P ¼ 0.003 and P ¼ 0033), and no intra-operative and early postoperative complications were registered [21].…”

Section: Key Pointsmentioning

confidence: 82%

“…For this reason, in many published studies, uterine size is included in the inclusion criteria. Nonetheless, Song et al [21] showed the feasibility of single-port hysterectomy also in uteri with a weight more than 500 g with a successful rate of 76.2%. The median operative time, uterine weight, and EBL were 110 (65-165) min, 600 (502-980) g, and 200 (100-800) ml, respectively.…”

Section: Key Pointsmentioning

confidence: 99%

Laparoendoscopic single-site hysterectomy

Fanfani

Monterossi

Fagotti

et al. 2014

Current Opinion in Obstetrics &Amp; Gynecology

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“…With the minimally invasive approach, the single incision laparoscopic technique has both advantages over laparotomy, such as faster return to normal activities, shorter duration of hospital stay, and reduced pain, as well as advantages over multi-incision laparoscopic surgery, such as improved cosmetics and reduced risks related to trocar insertion, for example, vessel injury, hematoma and infection [15,16,17]. Because of these advantages, single-site hysterectomy seems feasible but has considerable limitations, especially technical limitations, as previously mentioned.…”

Section: Discussionmentioning

confidence: 99%

Single Incision Trans-Umbilical Total Hysterectomy: Robotic or Laparoscopic?

Akdemir¹,

Yıldırım

Zeybek³

et al. 2015

Gynecol Obstet Invest

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Objective: The aim of this study was to compare the early surgical outcomes in patients who underwent total hysterectomy with laparoendoscopic single-site surgery (LESS-TH) versus robotic single-site total hysterectomy (RSS-TH). Methods: Twenty-four patients who underwent RSS-TH and thirty-four patients who underwent LESS-TH were retrospectively evaluated. Patient characteristics, operation time, intraoperative data (conversions, complications, estimated blood loss, etc.) and postoperative pain scores were compared. Results: The total operation time was significantly longer in the robotic surgery group, with a time of 98.5 vs. 86 min (p = 0.013), while vaginal closure time was significantly higher in the laparoscopic surgery group (p = 0.011). Intraoperative outcomes and postoperative pain scores were similar in the two groups. Conclusion: RSS-TH helps surgeons to overcome the technical disadvantages of LESS-TH, particularly vaginal cuff closure, ergonomics and instrument crowding and clashing. Early surgical outcomes are comparable in the two groups, and both techniques are safe and feasible.

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Single-Port Access Total Laparoscopic Hysterectomy for Large Uterus

Cited by 18 publications

References 33 publications

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

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

Laparoendoscopic single-site hysterectomy

Single Incision Trans-Umbilical Total Hysterectomy: Robotic or Laparoscopic?

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