Archives of Gynecology and Obstetrics

, Volume 284, Issue 4, pp 893–900 | Cite as

Transumbilical single-incision laparoscopic hysterectomy with conventional laparoscopic instruments in patients with symptomatic leiomyoma and/or adenomyosis

General Gynecology

Abstract

Purpose

To evaluate the feasibility, safety and perioperative outcome of single-incision laparoscopic hysterectomy (SILH) using conventional laparoscopic instruments for treatment of patients with symptomatic leiomyoma and/or adenomyosis.

Methods

A retrospective study (Canadian Task Force Classification II-2) was carried out at a tertiary referral university hospital from August 2009 to January 2010. Women diagnosed with leiomyoma/adenomyosis and scheduled to undergo SILH were enrolled. The criteria included uterine size ≤16 weeks’ gestation on pelvic examination, no suspected malignancy on sonography, normal cytology and contraindications for vaginal hysterectomy. The medical records of all consecutive patients undergoing SILH were reviewed. The main outcome measurements were the feasibility and safety of SILH in terms of conversion rate, body mass index (BMI), uterine weight, operative time, estimated blood loss, drop in hemoglobin level and complications.

Results

Eleven consecutive patients diagnosed with leiomyoma (10) and adenomyosis (1) underwent SILH successfully during the study period, without conversion or requirement of any extra port. The mean age and BMI of the patients were 47.4 ± 4.27 years and 25.2 ± 4.61 kg/m2, respectively. The average clinical uterine size and uterine weight were 13.2 ± 2.48 weeks’ gestation and 281.6 ± 152.89 g, respectively. The mean operative time was 163.3 ± 20.46 min. The mean estimated blood loss and drop in hemoglobin level were 114.5 ± 48.65 ml and 0.33 ± 0.62 g/dl, respectively. No intra-operative complication occurred. Postoperative febrile morbidity was found in two patients. The follow-up at 14 days and 6 weeks postoperatively was uneventful.

Conclusions

SILH using conventional laparoscopic instrumentation might be a feasible and safe alternative to standard multiple incision laparoscopic hysterectomy in selected patients with symptomatic benign uterine tumor. The potential advantages of our technique are: it is simple and cost-effective, due to the use of conventional, user-friendly laparoscopic instruments. Additional studies on SILH are needed to demonstrate its safety, define selective criteria and determine any benefits over conventional laparoscopic hysterectomy.

Keywords

Laparoscopy Single incision Single-port access Hysterectomy 

References

  1. 1.
    Romanelli JR, Earle DB (2009) Single-port laparoscopic surgery: an overview. Surg Endosc 23:1419–1427PubMedCrossRefGoogle Scholar
  2. 2.
    Canes D, Desai MM, Aron M, Haber GP, Goel RK, Stein RJ, Kaouk JH, Gill IS (2008) Transumbilical single-port surgery: evolution and current status. Eur Urol 54:1020–1029PubMedCrossRefGoogle Scholar
  3. 3.
    Wheeless CR Jr (1969) A rapid, inexpensive and effective method of surgical sterilization by laparoscopy. J Reprod Med 3:65–69Google Scholar
  4. 4.
    Pelosi MA, Pelosi MA III (1991) Laparoscopic hysterectomy with bilateral salpingo-oophorectomy using a single umbilical puncture. N J Med 88:721–726PubMedGoogle Scholar
  5. 5.
    Hernandez JM, Morton CA, Ross S, Albrink M, Rosemurgy AS (2009) Laparoendoscopic single site cholecystectomy: the first 100 patients. Am Surg 75:681–685PubMedGoogle Scholar
  6. 6.
    Kaouk JH, Haber GP, Goel RK, Desai MM, Aron M, Rackley RR, Moore C, Gill IS (2008) Single-port laparoscopic surgery in urology: initial experience. Urology 71:3–6PubMedCrossRefGoogle Scholar
  7. 7.
    Law WL, Fan JK, Poon JT (2010) Single-incision laparoscopic colectomy: early experience. Dis Colon Rectum 53:284–288PubMedCrossRefGoogle Scholar
  8. 8.
    Tacchino RM, Greco F, Matera D (2010) Laparoscopic gastric banding without visible scar: a short series with intraumbilical SILS. Obes Surg 20:236–239PubMedCrossRefGoogle Scholar
  9. 9.
    Fader AN, Escobar PF (2009) Laparoendoscopic single-site surgery (LESS) in gynecologic oncology: technique and initial report. Gynecol Oncol 114:157–161PubMedCrossRefGoogle Scholar
  10. 10.
    Fagotti A, Fanfani F, Marocco F, Rossitto C, Gallotta V, Scambia G (2009) Laparoendoscopic single-site surgery (LESS) for ovarian cyst enucleation: report of first 3 cases. Fertil Steril 92:1168.e13–1168.e16Google Scholar
  11. 11.
    Fanfani F, Fagotti A, Scambia G (2009) Laparoendoscopic single-site surgery for total hysterectomy. Int J Gynaecol Obstet 109:76–77PubMedCrossRefGoogle Scholar
  12. 12.
    Jung YW, Kim YT, Lee DW, Hwang YI, Nam EJ, Kim JH, Kim SW (2010) The feasibility of scarless single-port transumbilical total laparoscopic hysterectomy: initial clinical experience. Surg Endosc 24:1686–1692PubMedCrossRefGoogle Scholar
  13. 13.
    Kim TJ, Lee YY, Kim MJ, Kim CJ, Kang H, Choi CH, Lee JW, Kim BG, Bae DS (2009) Single port access laparoscopic adnexal surgery. J Minim Invasive Gynecol 16:612–615PubMedCrossRefGoogle Scholar
  14. 14.
    Langebrekke A, Qvigstad E (2009) Total laparoscopic hysterectomy with single-port access without vaginal surgery. J Minim Invasive Gynecol 16:609–611PubMedCrossRefGoogle Scholar
  15. 15.
    Mereu L, Angioni S, Melis GB, Mencaglia L (2010) Single access laparoscopy for adnexal pathologies using a novel reusable port and curved instruments. Int J Gynaecol Obstet 109:78–80PubMedCrossRefGoogle Scholar
  16. 16.
    Yoon G, Kim TJ, Lee YY, Kim CJ, Choi CH, Lee JW, Kim BG, Bae DS (2009) Single-port access subtotal hysterectomy with transcervical morcellation: a pilot study. J Minim Invasive Gynecol 17:78–81PubMedCrossRefGoogle Scholar
  17. 17.
    Phongnarisorn C, Srisomboon J (2007) Surgical morbidity associated with total laparoscopic hysterectomy in women with prior diagnostic excision of the cervix. J Obstet Gynaecol Res 33:519–523PubMedCrossRefGoogle Scholar
  18. 18.
    Lee YY, Kim TJ, Kim CJ, Kang H, Choi CH, Lee JW, Kim BG, Lee JH, Bae DS (2009) Single-port access laparoscopic-assisted vaginal hysterectomy: a novel method with a wound retractor and a glove. J Minim Invasive Gynecol 16:450–453PubMedCrossRefGoogle Scholar
  19. 19.
    Bonilla DJ, Mains L, Whitaker R, Crawford B, Finan M, Magnus M (2007) Uterine weight as a predictor of morbidity after a benign abdominal and total laparoscopic hysterectomy. J Reprod Med 52:490–498PubMedGoogle Scholar
  20. 20.
    Condous G, Bignardi T, Alhamdan D, Van CB, Van HS, Timmerman D, Lam A (2009) What determines the need to morcellate the uterus during total laparoscopic hysterectomy? J Minim Invasive Gynecol 16:52–55PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Faculty of MedicineChiang Mai UniversityChiang MaiThailand

Personalised recommendations