LESS hysterectomy through a bluntly created 11 mm incision

Abstract

In the field of minimally invasive surgery, there is a constant drive to devise and execute the most minimally invasive surgeries possible. By the very nature of laparoscopy and robotic surgery, what one can accomplish with several ports of a given size will invariably be studied and attempted with fewer ports and with ports of smaller sizes. After researching the literature, we were not able to find any single port hysterectomies performed through a port size of smaller than 15 mm. We were able to perform, described here, a technique for performing laparoscopic hysterectomy through a single port of only 11 mm in diameter. We illustrate the technique in the accompanying video and believe the technique to be safe and reproducible.

Keywords: Hysterectomy; LESS; single port; laparoendoscopic single site surgery; robotic hysterectomy; laparoscopic hysterectomy; laparoscopy.

Figure 1

An 11 mm incision is made at the bottom of the patient’s umbilicus with an 11-blade scalpel

Figure 2

A blunt 11 mm laparoscopic trochar is utilized to make the entry into the abdominal cavity, in order to avoid a sharp dissection into the abdomen which would result in a larger fascial footprint

Figure 3

A multiport device is then loaded into the introducer, for insertion into the abdomen

Figure 4

The multiport device is inserted through the abdominal incision after withdrawing the 11 mm blunt trochar. This ensures the incision width will not exceed 11 mm and has been created by blunt entry, which further decreases the chance of postoperative hernia

Figure 5

The multipart device is in place and the laparoscopic hysterectomy can proceed with one or two instruments in addition to the 5 mm laparoscope

Figure 6

The patient’s abdomen at a visit four weeks after surgery. No scars are visible

Figure 7

Secondary to the fact that laparoscopic incisions are stretched into a circular shape by the penetrating instrumentation, even a small decrease in the size of a fascial incision will greatly decrease the area of the opening that can pass through that incision. This figure compares the large jump from an area of 95 mm² to 177 mm² when increasing the umbilical incision by only 3 mm