The feasibility of scarless single-port transumbilical total laparoscopic hysterectomy: initial clinical experience.

OBJECTIVE: The purpose of the present study is to demonstrate the feasibility of single-port transumbilical laparoscopic surgery (SPLS) for hysterectomy and elaborate on our experience in order to introduce the single-port approach for gynecologic surgery.

METHODS: Between August 2008 and February 2009, 30 patients who initially planned to undergo single-port laparoscopic surgery at Yonsei University Health System in Seoul, Korea were enrolled in this study. The authors used a single-port three-channel system with a wound retractor, surgical gloves, and one 10/11-mm and two 5-mm trocars. All surgical procedures were performed with 30 degrees , 5-mm laparoscope, conventional laparoscopic instruments, and the LigaSure system (Valleylab, Boulder, CO, USA). Patient characteristics and surgical outcomes were prospectively evaluated. A visual analog score (VAS) scale was used to measure postoperative pain.

RESULTS: Twenty-nine of 30 patients underwent single-port laparoscopic surgery without conversion to laparotomy or conventional laparoscopic hysterectomy. Median operative time was 100 min (57-155 min), median blood loss was 100 ml (10-400 ml), median postoperative hospital stay was 3 days (2-6 days), and median weight of resected uteri was 167 g (45-482 g). VAS scoring of pain at 6, 24, and 48 h after surgery was 4, 3, and 2, respectively. There were no operative complications.

CONCLUSION: SPLS is a feasible approach for hysterectomy in terms of operative time, complication rates, and cosmetic results. However, the possible benefits for patients such as better cosmetic outcomes, reduced pain, and lower complication rates should be evaluated in randomized prospective studies.