Log in to MyKarger to check if you already have access to this content.

Buy FullText & PDF Unlimited re-access via MyKarger Unrestricted printing, no saving restrictions for personal use read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.

Save over 20% compared to the individual article price.

Learn more

Access via DeepDyve Unlimited fulltext viewing Of this article Organize, annotate And mark up articles Printing And downloading restrictions apply

Select

Subscribe Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use read more

Subcription rates

Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview

Received: April 12, 2022
Accepted: August 22, 2022
Published online: October 21, 2022

Number of Print Pages: 8
Number of Figures: 0
Number of Tables: 4

ISSN: 0378-7346 (Print)
eISSN: 1423-002X (Online)

For additional information: https://www.karger.com/GOI

Abstract

Objectives: Laparoendoscopic single-site surgery (LESS) and mini-laparoscopic surgery (Mini-LPS) have been performed with comparable results to conventional laparoscopy. However, there are few data on the comparison between them. Our main objective was to compare LESS and Mini-LPS in terms of surgical time, postoperative pain, and hospital stay in patients who underwent hysterectomy for benign pathology. Design: It is a retrospective international multicentric study carried out in 5 centers including 2 Spanish and 3 Italian. Methods: Data from patients who underwent hysterectomy for benign pathology between January 1, 2010, and December 31, 2015, were reviewed. We collected the clinical-pathological characteristics of the patients and the perioperative results. The main variables of the study were surgical time, the switch to oral analgesia, and the hospital stay. The two comparison groups in the study included patients undergoing hysterectomy for benign pathology by LESS or by Mini-LPS. The decision to perform the type of procedure was left to the discretion of the surgeon, based primarily on the surgical skills and experience of the center. All data were collected retrospectively by an online encrypted platform. Results: 161 patients were included in the study. 104 (64.6%) patients underwent LESS hysterectomy and 57 (35.4%) Mini-LPS. Median surgical time was significantly longer in the LESS group when compared to the Mini-LPS group (120 vs. 75 min, respectively; p < 0.001). Moreover, longer median hospital stay was observed in the LESS group compared to Mini-LPS (48 vs. 36 h, respectively; p < 0.001). Conversion of the technique to conventional LPS was performed in 4 (2.5%) patients, all of them in the Mini-LPS group (p = 0.015). Limitations: It is a retrospective study with the biases that this implies. Furthermore, some variables have been incompletely registered in the database, which implies loss of information. This is a nonrandomized study since the decision to intervene with one or another technique was made by the surgeon, which generated 2 nonhomogeneous groups in terms of the number of patients. On the other hand, all the patients who underwent Mini-LPS hysterectomy belonged to the same center, which may have made these results center dependent. Conclusions: Significant shorter surgical time and shorter hospital stay were observed in patients undergoing Mini-LPS hysterectomy compared to LESS technique; however, intraoperative complications related to instrumentation flaws were higher in the mini-LPS group that required conversion to standard laparoscopy in all cases. Both ultra-minimally invasive techniques seem safe to perform hysterectomies for benign pathology and emphasize the importance in surgical training to adapt them to our current practice.

© 2022 S. Karger AG, Basel

References Laganà AS, Garzon S, D’Alterio MN, Noventa M, Stabile G, Naem A, et al. Mini-laparoscopy or single-site robotic surgery in gynecology? Let’s think out of the box. J Invest Surg. 2022;35(2):440–1. Fanfani F, Fagotti A, Rossitto C, Gagliardi ML, Ercoli A, Gallotta V, et al. Laparoscopic, minilaparoscopic and single-port hysterectomy: perioperative outcomes. Surg Endosc. 2012;26(12):3592–6. Fanfani F, Fagotti A, Gagliardi ML, Monterossi G, Rossitto C, Costantini B, et al. Minilaparoscopic versus single-port total hysterectomy: a randomized trial. J Minim Invasive Gynecol. 2013;20(2):192–7. Demirayak G, Özdemir İA, Comba C, Aslan Çetin B, Aydogan Mathyk B, Yıldız M, et al. Comparison of laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopic (CMPL) surgery for hysterectomy: long-term outcomes of abdominal incisional scar. J Obstet Gynaecol. 2020;40(2):217–21. Uccella S, Cromi A, Casarin J, Bogani G, Serati M, Gisone B, et al. Minilaparoscopic versus standard laparoscopic hysterectomy for Uteri ≥16 weeks of gestation: surgical outcomes, postoperative quality of life, and cosmesis. J Laparoendosc Adv Surg Tech. 2015;25(5):386–91. Béguinot M, Botchorishvili R, Comptour A, Curinier S, Campagne-Loiseau S, Chauvet P, et al. Minilaparoscopic total hysterectomy in current practice feasibility and benefits: a unicentric, randomized controlled trial. J Minim Invasive Gynecol. 2020 Mar;27(3):673–80. Uccella S, Buda A, Morosi C, Di Martino G, Delle Marchette M, Reato C, et al. Minilaparoscopy vs standard laparoscopy for sentinel node dissection: a pilot study. J Minim Invasive Gynecol. 2018;25(3):461–6.e1. Fagotti A, Ghezzi F, Boruta DM, Scambia G, Escobar P, Fader AN, et al. Minilaparoscopic radical hysterectomy (mLPS-RH) vs laparoendoscopic single-site radical hysterectomy (less-rh) in early stage cervical cancer: a multicenter retrospective study. J Minim Invasive Gynecol. 2014;21(6):1005–9. Gallotta V, Nero C, Chiantera V, Scambia G. Minilaparoscopic aortic lymphadenectomy. J Minim Invasive Gynecol. 2015;22(4):546–7. Rossitto C, Cianci S, Gueli Alletti S, Perrone E, Pizzacalla S, Scambia G. Laparoscopic, minilaparoscopic, single-port and percutaneous hysterectomy: comparison of perioperative outcomes of minimally invasive approaches in gynecologic surgery. Eur J Obstet Gynecol Reprod Biol X. 2017;216:125–9. Cerovac A, Habek D, Hudić I, Kamerić L. Laparoendoscopic ovarian-sparing surgery of adnexal tumors in children and adolescents by general gynecologists: a 10-year, retrospective cohort study. J Laparoendoscopic Adv Surg Tech. 2021;31(9):1055–60. Casarin J, Laganà AS, Pinelli C, Cromi A, Ghezzi F. Minilaparoscopic single-site bilateral salpingo-oophorectomy: a scarless prophylactic procedure. Minim Invasive Ther Allied Technol. 2022;31(2):313–8. Ghezzi F, Cromi A, Siesto G, Uccella S, Boni L, Serati M, et al. Minilaparoscopic versus conventional laparoscopic hysterectomy: results of a randomized trial. J Minim Invasive Gynecol. 2011;18(4):455–61. Ferreira H, Ferreira C, Nogueira-Silva C, Tomé A, Guimarães S, Correia-Pinto J. Minilaparoscopic versus conventional laparoscopic sacrocolpopexy: a comparative study. J Laparoendoscopic Adv Surg Tech. 2016;26(5):386–92. Fagotti A, Bottoni C, Vizzielli G, Alletti SG, Scambia G, Marana E, et al. Postoperative pain after conventional laparoscopy and laparoendoscopic single site surgery (LESS) for benign adnexal disease: a randomized trial. Fertil Steril. 2011;96(1):255–9.e2. Park J-Y, Kim D-Y, Suh D-S, Kim J-H, Nam J-H. Laparoendoscopic single-site versus conventional laparoscopic surgical staging for early-stage endometrial cancer. Int J Gynecol Cancer. 2014;24(2):358–63. Sandberg EM, la Chapelle CF, van den Tweel MM, Schoones JW, Jansen FW. Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta- analysis. Arch Gynecol Obstet. 2017;295(5):1089–103. Fader AN, Rojas-Espaillat L, Ibeanu O, Grumbine FC, Escobar PF. Laparoendoscopic single-site surgery (LESS) in gynecology: a multi-institutional evaluation. Am J Obstet Gynecol. 2010;203(5):501.e1–501.e6. Paek J, Kim S-W, Lee S-H, Lee M, Yim G-W, Nam E-J, et al. Learning curve and surgical outcome for single-port access total laparoscopic hysterectomy in 100 consecutive cases. Gynecol Obstet Invest. 2011;72(4):227–33. de’Angelis N, Petrucciani N, Giannandrea G, Brunetti F. The protocol of low - impact laparoscopic cholecystectomy: the combination of mini – laparoscopy and low – pressure pneumoperitoneum. Updates Surg. 2018;70(4):553–6. Kaya C, Alay I, Cengiz H, Yıldız GO, Baghaki HS, Yasar L. Comparison of hysterectomy cases performed via conventional laparoscopy or vaginally assisted natural orifice transluminal endoscopic surgery: a paired sample cross-sectional study. J Obstet Gynaecol. 2021;41(3):434–8. Härkki-SirÉn P, SjÖberg J, Toivonen J, Tiitinen A. Clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy: a randomized controlled study. Acta Obstet Gynecol Scand. 2000;79(10):866–71. Ghezzi F, Cromi A, Siesto G, Boni L, Uccella S, Bergamini V, et al. Needlescopic hysterectomy: incorporation of 3-mm instruments in total laparoscopic hysterectomy. Surg Endosc. 2008 Oct;22(10):2153–7. Antoniou SA, Morales-Conde S, Antoniou GA, Granderath FA, Berrevoet F, Muysoms FE. Single-incision laparoscopic surgery through the umbilicus is associated with a higher incidence of trocar-site hernia than conventional laparoscopy: a meta-analysis of randomized controlled trials. Hernia. 2016;20(1):1–10. Kaya C, Alay I, Cengiz H, Baghaki S, Aslan O, Ekin M, et al. Conventional laparoscopy or vaginally assisted natural orifice transluminal endoscopic surgery for adnexal pathologies: a paired sample cross-sectional study. J Invest Surg. 2020;34(11):1185–90. Article / Publication Details

First-Page Preview

Received: April 12, 2022
Accepted: August 22, 2022
Published online: October 21, 2022

Number of Print Pages: 8
Number of Figures: 0
Number of Tables: 4

ISSN: 0378-7346 (Print)
eISSN: 1423-002X (Online)

For additional information: https://www.karger.com/GOI