Single-incision total laparoscopic hysterectomy

Abstract

Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. We perform single-incision total laparoscopic hysterectomy using three ports in the single transumbilical incision.

Keywords: E-NOTES; SILS; single-incision laparoscopic surgery; single-port surgery; transumbilical surgery.

Figure 1

Single intraumbilical incision

Figure 2

Single-incision one 10 mm and two 5 mm ports

Figure 3

Uterus bulky

Figure 4

Right round ligament desiccated and cut with harmonic

Figure 5

Window made in broad ligament

Figure 6

Left uterine artery sutured

Figure 7

Right uterine artery sutured

Figure 8

Left cornuals desiccated and cut

Figure 9

Right cornuals desiccated and cut

Figure 10

Vaginal vault opened

Figure 11

Vault sutured laparoscopically

Figure 12

Final view

Figure 13

Skin closed with subcuticular sutures