Feasibility of reduced port surgery applying Higuchi's transverse incision

Abstract

Objective: Higuchi's transverse incision is made at a lower position than the Pfannenstiel transverse incision and is superior in terms of cosmetic outcomes. The purpose of this study was to examine the safety and efficacy of novel forms of reduced port surgery for ovarian cysts and uterine fibroids applying Higuchi's transverse incision.

Methods: In 33 patients with ovarian cysts who underwent low-position single-incision laparoscopic surgery (L-SILS)-modified single-port laparoscopy placed in the 2-3-cm Higuchi's incision above the pubis, patient's characteristics and perioperative outcomes were compared with those of patients who underwent multiport laparoscopy (n = 53). In addition, 18 patients with uterine fibroids who underwent dual-port laparoscopically assisted myomectomy without using power morcellators and conventional four-port laparoscopically assisted myomectomy were investigated.

Results: There were no significant differences between L-SILS and multiport laparoscopy in tumor diameter, bleeding, hospital stay, or postoperative pain. However, the L-SILS group demonstrated significantly shorter operative and pneumoperitoneum times (p < 0.01 and p < 0.01). In comparison with cases of uterine fibroids, no significant differences were found in maximum fibroid diameter, operative time, pneumoperitoneum time, or bleeding. However, the dual-port laparoscopically assisted myomectomy group demonstrated a significantly shorter length of hospital stay than the conventional laparoscopically assisted myomectomy group (p < 0.05).

Conclusion: We reported novel forms of reduced port surgery applying Higuchi's transverse incision. It was suggested that these procedures are relatively simple, but ensure the same safety and efficacy as conventional methods. We intend to increase the number of cases and examine safety, efficacy, and patient satisfaction for these procedures.

Keywords: laparoscopically assisted myomectomy; power morcellator; reduced port surgery.

Figure 1

L-SILS applying Higuchi’s transverse incision. (A) The skin incision made at the superior margin on the pubis. (B) The platform is placed in the 2–3-cm Higuchi’s transverse incision. Three trocars are attached to the EZ access. L-SILS = low-position single-incision laparoscopic surgery.

Figure 2

Dual-port LAM applying Higuchi’s transverse incision. (A) The 5-mm trocar for the videoscope is inserted through the umbilicus by the optical method. The platform is placed in the 3-cm Higuchi’s transverse incision above the pubis. Two trocars are attached to the EZ access. (B) The enucleated fibroid from the uterus is collected into an isolation bag, manually morcellated with a scalpel in the bag, and removed from the abdominal cavity via the Higuchi’s transverse incision. LAM = laparoscopically assisted myomectomy.