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Abdominal, multi-port and single-port total laparoscopic hysterectomy: eleven-year trends comparison of surgical outcomes complications of 936 cases

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To compare surgical outcomes and complications of 284 patients who had total abdominal hysterectomy (TAH), 366 patients who had multi-port access total laparoscopic hysterectomy (MPA-TLH), and 286 patients who had single-port access total laparoscopic hysterectomy (SPA-TLH) using a transumbilical single-port system.

Methods

A retrospective study was conducted on a cohort of women who underwent TAH, MPA-TLH, or SPA-TLH for benign gynecologic diseases at DaeJeon St. Mary’s Hospital, between January 2003 and December 2013. Surgical outcomes and complications were compared between the three groups.

Results

The total operative time (min) was longest in the SPA-TLH group (188.3 ± 51.3), followed by the TAH (176.4 ± 47.9) and MPA-TLH (149.3 ± 59.5) groups (p < 0.05). The estimated blood loss (mL) did not differ between MPA-TLH and SPA-TLH (163.8 ± 168.9 vs. 176.9 ± 197.8 mL), but it was the greatest in TAH (427.1 ± 250.6, p < 0.05). The weight of the uterus (gm) was highest in TAH (375.8 ± 380.1, p < 0.05) and similar in MPA-TLH and SPA-TLH (10.1 ± 2.6 vs. 9.7 ± 2.6 cm). The hospital stay (days) was longest in the TAH (7.0 ± 2.1) and SPA-TLH (6.3 ± 2.0) groups, followed by the MPA-TLH (5.5 ± 2.0) group (p < 0.05). The major complication rate was 2.5 % (7 cases) in the TAH group, 5.5 % (20 cases) in the MPA-TLH group, and 0.7 % (2 cases) in the SPA-TLH group. In the MPA-TLH group, the complication rate of the first half of the cases was significantly higher than in the latter half of cases, especially with regards to vaginal cuff dehiscence (p < 0.05). In the SPA-TLH group, no statistically significant difference was found between the two sub-groups.

Conclusions

Our study showed that MPA-TLH and SPA-TLH were feasible and safe when compared to TAH. Furthermore, after acquiring technical skills in laparoscopic surgery, conversion from MPA-TLH to SPA-TLH might be easier than the initial conversion from laparotomy to laparoscopy. The advantage of SPA-TLH over MPA-TLH is questionable, considering the longer learning curve; however SPA-TLH is an effective alternative for both the patient and surgeon.

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References

  1. Reich H, DeCaprio J, McGlynn F (1989) Laparoscopic hysterectomy. J Gynecol Surg 5:213–216

    Article  Google Scholar 

  2. Pelosi MA (1991) Laparoscopic hysterectomy with bilateral salpingo-oophorectomy using a single umbilical puncture. N J Med 88:721–726

    CAS  PubMed  Google Scholar 

  3. Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R (2005) Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ 330:1478

    Article  PubMed Central  PubMed  Google Scholar 

  4. Raju KS, Auld BJ (1994) A randomised prospective study of laparoscopic vaginal hysterectomy versus abdominal hysterectomy each with bilateral salpingo-oophorectomy. Br J Obstet Gynaecol 101:1068–1071

    Article  CAS  PubMed  Google Scholar 

  5. Fader AN, Rojas-Espaillat L, Ibeanu O, Grumbine FC, Escobar PF (2010) Laparoendoscopic single-site surgery (LESS) in gynecology: a multi-institutional evaluation. Am J Obstet Gynecol 203:501

    PubMed  Google Scholar 

  6. Lee M, Kim SW, Nam EJ, Yim GW, Kim S, Kim YT (2012) Single-port laparoscopic surgery is applicable to most gynecologic surgery: a single surgeon’s experience. Surg Endosc 26:1318–1324

    Article  PubMed  Google Scholar 

  7. Jung YW, Kim YT, Lee DW, Hwang YI, Nam EJ, Kim JH et al (2010) The feasibility of scarless single-port transumbilical total laparoscopic hysterectomy: initial clinical experience. Surg Endosc 24:1686–1692

    Article  PubMed  Google Scholar 

  8. Kim TJ, Lee YY, Kim MJ, Kim CJ, Kang H, Choi CH et al (2009) Single port access laparoscopic adnexal surgery. J Minim Invasive Gynecol 16:612–615

    Article  PubMed  Google Scholar 

  9. Lee YY, Kim TJ, Kim CJ, Kang H, Choi CH, Lee JW et al (2009) Single-port access laparoscopic-assisted vaginal hysterectomy: a novel method with a wound retractor and a glove. J Minim Invasive Gynecol 16:450–453

    Article  PubMed  Google Scholar 

  10. Mäkinen J, Johansson J, Tomás C, Tomás E, Heinonen PK, Laatikainen T et al (2001) Morbidity of 10110 hysterectomies by type of approach. Hum Reprod 16:1473–1478

    Article  PubMed  Google Scholar 

  11. Lepine LA, Hillis SD, Marchbanks PA, Koonin LM, Morrow B, Kieke BA et al (1997) Hysterectomy surveillance-United States, 1980–1993. MMWR CDC Surveill Summ 46:1–15

    CAS  PubMed  Google Scholar 

  12. Lee JH, Choi JS, Hong JH, Joo KJ, Kim BY (2011) Does conventional or single port laparoscopically assited vaginal hysterectomy affect female sexual function? Acta Obstet Gynecol Scand 90:1410–1415

    Article  PubMed  Google Scholar 

  13. Choi YS, Park JN, Oh YS, Sin KS, Choi J, Eun DS (2013) Single-port vs. conventional multi-port access laparoscopy-assisted vaginal hysterectomy: comparison of surgical outcomes and complications. Eur J Obstet Gynecol Reprod Biol 169:366–369

    Article  PubMed  Google Scholar 

  14. Kim HO, Yoo CH, Lee SR, Son BH, Park YL, Shin JH et al (2012) Pain after laparoscopic appendectomy: a comparison of transumbilical single-port and conventional laparoscopic surgery. J Korean Surg Soc 82:172–178

    Article  PubMed Central  PubMed  Google Scholar 

  15. Deveci U, Barbaros U, Kapakli MS, Manukyan MN, Simşek S, Kebudi A et al (2013) The comparison of single incision laparoscopic cholecystectomy and three port laparoscopic cholecystectomy: prospective randomized study. J Korean Surg Soc 85:275–282

    Article  PubMed Central  PubMed  Google Scholar 

  16. McPherson K, Metcalfe MA, Herbert A, Maresh M, Casbard A, Hargreaves J et al (2004) Severe complications of hysterectomy: the VALUE study. BJOG 111:688–694

    Article  CAS  PubMed  Google Scholar 

  17. Magrina JF (2007) Complications of laparoscopic surgery. Clin Obstet Gynecol 45:469–480

    Article  Google Scholar 

  18. Park JY, Kim TJ, Kang HJ, Lee YY, Choi CH, Lee JW et al (2013) Laparoendoscopic single site (LESS) surgery in benign gynecology: perioperative and late complications of 515 cases. Eur J Obstet Gynecol Reprod Biol 167:215–218

    Article  PubMed  Google Scholar 

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Acknowledgments

We acknowledge the assistance of staff and residents, Department of Obstetrics and Gynecology, The Catholic University of Korea Daejeon St. Mary’s Hospital for their help.

Conflict of interest

There are no conflicts of interest.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, The Catholic University of Korea Daejeon St. Mary’s Hospital, 520-2, Daehung-dong, Jung-gu, Daejeon, 301-723, Korea

    Su Mi Kim, Eun Kyung Park, In Cheul Jeung & Yong Seok Lee

  2. Department of Obstetrics and Gynecology, St. Paul’s Hospital, The Catholic University of Korea, 180 Wangsan-ro, Dongdaemun-gu, Seoul, 130-709, Korea

    Chan Joo Kim

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  1. Su Mi Kim
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  2. Eun Kyung Park
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  3. In Cheul Jeung
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Correspondence to Yong Seok Lee.

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Kim, S.M., Park, E.K., Jeung, I.C. et al. Abdominal, multi-port and single-port total laparoscopic hysterectomy: eleven-year trends comparison of surgical outcomes complications of 936 cases. Arch Gynecol Obstet 291, 1313–1319 (2015). https://doi.org/10.1007/s00404-014-3576-y

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  • DOI: https://doi.org/10.1007/s00404-014-3576-y

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