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. 2025 Mar 10;22(1):83-95.
doi: 10.4274/tjod.galenos.2025.09804.

Comparative analysis of laparoendoscopic single-site surgery and versus conventional laparoscopic surgery in adnexectomy: A systematic review and metaanalysis of surgical outcome

Greg J Marchand  1 , Hollie Ulibarri  1 , Amanda Arroyo  1 , Daniela Gonzalez  1 , Brooke Hamilton  1 , Kate Ruffley  1 , Marissa Dominick  2 , Ali Azadi  3
Affiliations

Comparative analysis of laparoendoscopic single-site surgery and versus conventional laparoscopic surgery in adnexectomy: A systematic review and metaanalysis of surgical outcome

Greg J Marchand et al. Turk J Obstet Gynecol. .

Abstract
in English, Turkish

Although the removal of the adnexa technically removes more tissue, it may require less fine manipulation and dissection than cystectomy. Secondary to this, we sought to measure the effectiveness and safety of laparoendoscopic single-site surgery (LESS) versus conventional laparoscopy (CLS). We search six databases to find studies comparing LESS and CLS for ovarian lesions where removal of the entire ovary, with or without the fallopian tube, is necessary. Criteria used for study eligibility: both controlled trials and observational studies were included in this analysis. Study appraisal and synthesis methods: we used the Cochrane risk of bias assessment tool for the randomized clinical trials and the national heart, lung, and blood quality assessment tools for the observational studies. The statistical analysis was done using the review manager software. LESS showed a significantly longer operative time [mean difference (MD)=2.96 (-1.97, 7.90), p=0.24], but with moderate heterogeneity. Estimated blood loss was significantly lower for LESS [MD=-18.62 (-33.83, -3.42), p=0.02]. The length of patient hospital stay was comparable [MD=-0.02 (-0.50, 0.47), p=0.95]. Visual analog scale (VAS) pain scores at 24 hours [MD=0.23 (-0.09, 0.56), p=0.16] and 6 hours postoperatively [MD=0.15 (-0.04, 0.33), p=0.12] were similar. The LESS group required less postoperative analgesia [risk ratios (RR)=0.47 (0.32, 0.68), p=0.001]. The change in hemoglobin was comparable [MD=-0.11 (-0.26, 0.03), p=0.14]. Perioperative complications were higher in the LESS group [RR=2.236 (1.031, 4.851), p=0.04]. Compared with CLS, LESS required more operative time but resulted in significantly less blood loss and lower postoperative analgesic use. Hospital stays and VAS pain scores were similar. LESS had a higher incidence of perioperative complications, which questions the feasibility of its use in some situations.

Adnekslerin çıkarılması teknik olarak daha fazla doku çıkarsa da, kistektomiye göre daha az ince manipülasyon ve diseksiyon gerektirebilir. Bu durumu araştırmanın yanı sıra, bu yazıda, laparoendoskopik tek-bölge cerrahisinin (LTBC) konvansiyonel laparoskopiye (KL) göre etkinliğini ve güvenliğini ölçmeyi de amaçladık. Fallop tüpü çıkarılarak veya çıkarılmadan tüm yumurtalığın çıkarılmasının gerekli olduğu yumurtalık lezyonlarında LTBC ve KL’yi karşılaştıran çalışmaları bulmak için altı veritabanını taradık. Bu analize hem kontrollü çalışmalar hem de gözlemsel çalışmalar dahil edildi. Çalışma değerlendirme ve sentez yöntemleri: randomize kontrollü çalışmalar için Cochrane bias riski değerlendirme aracını ve gözlemsel çalışmalar için ulusal kalp, akciğer ve kan kalite değerlendirme araçlarını kullandık. İstatistiksel analiz Review Manager yazılımı kullanılarak yapıldı. LTBC, orta düzeyde heterojenlik ile anlamlı olarak daha uzun bir ameliyat süresi [ortalama fark (OF)=2,96 (-1,97, 7,90), p=0,24] ile ilişkili idi. Tahmini kan kaybı, LTBC’de anlamlı olarak daha az idi [OF=-18,62 (-33,83, -3,42), p=0,02]. Hastanede kalış süresi LTBC ve KL’de benzer idi [OF=-0,02 (-0,50, 0,47), p=0,95]. Postoperatif 24. saatteki [OF=0,23 (-0,09, 0,56), p=0,16] ve 6. saatteki [OF=0,15 (-0,04, 0,33), p=0,12] görsel analog ölçek (GAÖ) ağrı skorları benzerdi. LTBC grubu daha az postoperatif analjeziye ihtiyaç duydu [risk oranları (RO)=0,47 (0,32, 0,68), p=0,001]. Hemoglobin değişimi her iki grupta da benzerdi [OF=-0,11 (-0,26, 0,03), p=0,14]. Perioperatif komplikasyonlar LTBC grubunda daha yüksekti [RO=2,236 (1,031, 4,851), p=0,04]. KL ile karşılaştırıldığında, LTBC daha uzun ameliyat süresi ile ilişkili idi; ancak anlamlı olarak daha az kan kaybı ve daha az postoperatif analjezik kullanımıyla sonuçlandı. Hastanede kalış süreleri ve GAÖ ağrı skorları benzerdi. LTBC’nin daha yüksek bir perioperatif komplikasyon insidansı vardı, bu da bazı durumlarda uygulanabilirliğini sorgulatıyordu.

Keywords: Adnexectomy; conventional laparoscopic surgery; laparoendoscopic single-site surgery; meta-analysis; minimally invasive surgery.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
Prisma flow diagram of our literature search
Figure 10
Figure 10
Meta-analysis of the perioperative complication rate CI: Confidence interval
Figure 11
Figure 11
Meta-analysis of body mass index LESS: Laparoendoscopic single-site surgery, CLS: Conventional laparoscopy, CI: Confidence interval, SD: Standard deviation, IV: Inverse variance
Figure 12
Figure 12
Meta-analysis of patient history of previous abdominal surgery LESS: Laparoendoscopic single-site surgery, CLS: Conventional laparoscopy, CI: Confidence interval, SD: Standard deviation, IV: Inverse variance
Figure 2
Figure 2
Details of the risk of bias assessment of the included randomized clinical trials
Figure 3
Figure 3
Meta-analysis of the total operative time LESS: Laparoendoscopic single-site surgery, CLS: Conventional laparoscopy, CI: Confidence interval, SD: Standard deviation, IV: Inverse variance
Figure 4
Figure 4
Meta-analysis of the length of hospital stay (in days) LESS: Laparoendoscopic single-site surgery, CLS: Conventional laparoscopy, CI: Confidence interval, SD: Standard deviation, IV: Inverse variance
Figure 5
Figure 5
Meta-analysis of estimated blood loss LESS: Laparoendoscopic single-site surgery, CLS: Conventional laparoscopy, CI: Confidence interval, SD: Standard deviation, IV: Inverse variance
Figure 6
Figure 6
Meta-analysis of VAS pain scores at 24 hours after surgery LESS: Laparoendoscopic single-site surgery, CLS: Conventional laparoscopy, CI: Confidence interval, SD: Standard deviation, VAS: Visual analog scale, IV: Inverse variance
Figure 7
Figure 7
Meta-analysis of VAS pain scores at 6 hours after surgery LESS: Laparoendoscopic single-site surgery, CLS: Conventional laparoscopy, CI: Confidence interval, SD: Standard deviation, IV: Inverse variance
Figure 8
Figure 8
Meta-analysis of opioid analgesia usage in the postoperative period LESS: Laparoendoscopic single-site surgery, CLS: Conventional laparoscopy, CI: Confidence interval, SD: Standard deviation
Figure 9
Figure 9
Meta-analysis of the change in hemoglobin postoperatively (in g/dL) LESS: Laparoendoscopic single-site surgery, CLS: Conventional laparoscopy, CI: Confidence interval, SD: Standard deviation, IV: Inverse variance
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