Single-port vs. conventional multi-port access laparoscopy-assisted vaginal hysterectomy: comparison of surgical outcomes and complications

Abstract

Objective: To compare surgical outcomes and complications between single-port access (SPA) and multi-port access (MPA) laparoscopy-assisted vaginal hysterectomy (LAVH).

Study design: A retrospective review of medical records was performed in patients who underwent LAVH for non-malignant gynaecological diseases at Eun Hospital between April 2010 and April 2012. One hundred and twenty women underwent SPA LAVH using a transumbilical three-channel single-port system and 130 women underwent conventional MPA LAVH. Surgical outcomes and complications were compared between the two groups.

Results: The outcomes of the SPA-LAVH group vs. the conventional MPA-LAVH group were as follows: mean±standard deviation total operative time (73.1±24.3 vs. 70.3±22.1min, p=0.349), largest dimension of uterus (10.7±2.3 vs. 10.8±2.8cm, p=0.847), weight of extirpated uterus (311±185 vs. 339±234g, p=0.298) and change in haemoglobin (1.7±0.8 vs. 2.0±0.9g/dl, p=0.025). The incidence of complications was similar in each group (20 vs. 16 patients, p=0.327). Unplanned intra-operative laparotomy was not necessary in either group, and there were no cases of bowel injury or main vessel injury in either group. In total, there were three bladder injuries: one in the SPA-LAVH group and two in the MPA-LAVH group. The postoperative course was uneventful in most patients, but six patients had a transient paralytic ileus (four in the SPA-LAVH group and two in the MPA-LAVH group) and 10 patients had a pelvic haematoma (five in each group), all of whom recovered following conservative management. Port-related complications were rare, but one patient in the SPA-LAVH group had a port-site umbilical hernia.

Conclusion: Use of SPA and MPA LAVH has similar results in terms of surgical outcomes and complications.

Keywords: Hysterectomy; LAVH; LESS; Single port; Single site.