Laparoendoscopic single-site surgery in gynecology: review of literature and available technology

Abstract

The objective of this article was to review the published literature on laparoendoscopic single-site surgery (LESS) in gynecology and to present current advances in instruments used in LESS surgery. Inasmuch as LESS surgery is relatively new, the current literature on use of this technique in gynecology is somewhat limited. Sixteen articles were available for the literature review: 10 case series, 2 comparative studies, 3 case reports, and 1 surgical technique demonstration. In recent years, however, improvements in traditional laparoscopic techniques and availability of more advanced instruments has made single-incision laparoscopy more feasible and safer for the patient. There is increasing interest in LESS surgery both as an alternative to traditional laparoscopy and as an adjunct to robotic surgery when performing complicated procedures through a single incision. Although LESS surgery provides another option in the arena of minimally invasive gynecologic surgery, the ultimate role of this approach remains to be determined.

Fig. 1

Access Ports: (A) AirSeal port (SurgiQuest, Orange, CA) (B) SILS port (Covidien, Mansfield, MA) (C) TriPort multichannel access port (Advanced Surgical Concepts, Ireland) (D) GelPort laparoscopic system (Applied Medical, Rancho Santa Margarita, CA)

Fig. 2

Instruments for LESS Surgery (A) RealHand high-dexterity instruments (Novare Surgical, Cupertino, CA) (B) SILS kit for LESS surgery with Roticulator instruments (Covidien, Mansfield, MA) (C) Autonomy Laparo-Angle instruments (Cambridge Endoscopic Devices, Framingham, MA)

Fig. 3

Olympus deflectable-tip EndoEYE video laparoscope (Olympus America, Center Valley, PA).

Fig. 4

Single-port access created using Gelpoint device.

Fig. 5

X-Cone access port and S-Portal curved instruments (Karl Storz, Tuttlingen, Germany), the first generation of curved coaxial instruments with double bending.