Journal List > Korean J Obstet Gynecol > v.55(6) > 1088459

Korean J Obstet Gynecol. 2012 Jun;55(6):392-397. Korean.
Published online June 16, 2012.  https://doi.org/10.5468/KJOG.2012.55.6.392
Copyright © 2012. Korean Society of Obstetrics and Gynecology
Single port access laparoscopic hysterectomy for large uterus of more than 500 g
Geon-Woo Lee, MD, Jang-Keu Kim, MD, Chang-Su Shin, MD, Won-Kyu Choi, MD, Byung-Hun Kang, MD, Jung-bo Yang, MD, Young-bok Koh, MD and Ki-Hwan Lee, MD, PhD
Department of Obstetrics and Gynecology, Chungnam National University School of Medicine, Daejeon, Korea.

Corresponding author: Ki-Hwan Lee, MD. Department Obstetrics and Gynecology, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. Tel: +82-42-280-7269, Fax: +82-42-280-7264, Email: oldfox@cnuh.co.kr
Received March 17, 2012; Accepted April 23, 2012.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Objective

To compare the outcomes of single port access (SPA) laparoscopic hysterectomy and conventional laparoscopic hysterectomy for the large uterus of more than 500 g.

Methods

Twenty-seven cases of SPA laparoscopic hysterectomy and 32 cases of conventional laparoscopic hysterectomy were retrospectively analysed. The surgery had performed by single surgeon from January 2010 to July 2011 in Chungnam National University Hospital. We compared demographic characteristics and surgical outcomes.

Results

There were no significant difference in patients' age, body mass index, past surgical history, postoperative additional pain control and duration of hospital stay between the two groups. Uterine weight was 706.5±363.2 g (range, 500-2,415 g) for SPA laparoscopic hysterectomy and 634.0±153.3 g (range, 500-1,130 g) for conventional laparoscopic hysterectomy and significantly not different between the two groups. Operation time was significantly longer in SPA laparoscopic hysterectomy than conventional laparoscopic hysterectomy (81.1±18.1 minutes vs. 67.2±16.8 minutes). Postoperative change in hemoglobin and hematocrit was statistically higher in SPA laparoscopic hysterectomy than conventional laparoscopic hysterectomy (1.9±0.9 g/dL, 2.9±4.2% vs. 1.0±1.3 g/dL, 6.2±2.9%, respectively).

Conclusion

Operation time was longer and postoperative change in hemoglobin and hematocrit was significantly higher in SPA laparoscopic hysterectomy than conventional laparoscopic hysterectomy. However, SPA laparoscopic hysterectomy will replace conventional laparoscopic hysterectomy in a future with improving surgical technique.

Keywords: Single port access; Large uterus; Hysterectomy; Laparoscopy

Tables


Table 1
Comparison of demographic characteristics in 59 patients who had undertaken laparoscopic hysterectomy either by SPA or conventional method
Click for larger image


Table 2
Comparison of postoperative outcomes in 59 patients who had undertaken laparoscopic hysterectomy either by SPA or conventional method
Click for larger image

References
1. Reich H, DiCaprio J, McGlynn F. Laparoscopic hysterectomy. J Gynecol Surg 1989;5:213–216.
2. Quiñones GR, Alvarado DA, Ley Ch E. Tubal ligation using Yoon's ring. Ginecol Obstet Mex 1976;40:127–136.
3. Pelosi MA, Pelosi MA 3rd. Laparoscopic hysterectomy with bilateral salpingo-oophorectomy using a single umbilical puncture. N J Med 1991;88:721–726.
4. Podolsky ER, Rottman SJ, Poblete H, King SA, Curcillo PG. Single port access (SPA) cholecystectomy: a completely transumbilical approach. J Laparoendosc Adv Surg Tech A 2009;19:219–222.
5. Canes D, Desai MM, Aron M, Haber GP, Goel RK, Stein RJ, et al. Transumbilical single-port surgery: evolution and current status. Eur Urol 2008;54:1020–1029.
6. Kommu SS, Kaouk JH, Rané A. Laparo-endoscopic single-site surgery: preliminary advances in renal surgery. BJU Int 2009;103:1034–1037.
7. Romanelli JR, Roshek TB 3rd, Lynn DC, Earle DB. Single-port laparoscopic cholecystectomy: initial experience. Surg Endosc 2010;24:1374–1379.
8. Canes D, Berger A, Aron M, Brandina R, Goldfarb DA, Shoskes D, et al. Laparo-endoscopic single site (LESS) versus standard laparoscopic left donor nephrectomy: matched-pair comparison. Eur Urol 2010;57:95–101.
9. Teixeira J, McGill K, Binenbaum S, Forrester G. Laparoscopic single-site surgery for placement of an adjustable gastric band: initial experience. Surg Endosc 2009;23:1409–1414.
10. Moris DN, Bramis KJ, Mantonakis EI, Papalampros EL, Petrou AS, Papalampros AE. Surgery via natural orifices in human beings: yesterday, today, tomorrow. Am J Surg. 2011 Dec 27;
11. Paek J, Nam EJ, Kim YT, Kim SW. Overcoming technical difficulties with single-port access laparoscopic surgery in gynecology: using conventional laparoscopic instruments. J Laparoendosc Adv Surg Tech A 2011;21:137–141.
12. Paek J, Kim SW, Lee SH, Lee M, Yim GW, Nam EJ, et al. Learning curve and surgical outcome for single-port access total laparoscopic hysterectomy in 100 consecutive cases. Gynecol Obstet Invest 2011;72:227–233.
13. Lee M, Kim SW, Nam EJ, Yim GW, Kim S, Kim YT. Single-port laparoscopic surgery is applicable to most gynecologic surgery: a single surgeon's experience. Surg Endosc 2012;26:1318–1324.
14. Song T, Kim TJ, Kim MK, Park H, Kim JS, Lee YY, et al. Single port access laparoscopic-assisted vaginal hysterectomy for large uterus weighing exceeding 500 grams: technique and initial report. J Minim Invasive Gynecol 2010;17:456–460.
15. Ichikawa M, Akira S, Mine K, Ohuchi N, Iwasaki N, Kurose K, et al. Evaluation of laparoendoscopic single-site gynecologic surgery with a multitrocar access system. J Nihon Med Sch 2011;78:235–240.
16. Yim GW, Jung YW, Paek J, Lee SH, Kwon HY, Nam EJ, et al. Transumbilical single-port access versus conventional total laparoscopic hysterectomy: surgical outcomes. Am J Obstet Gynecol 2010;203:26.e1–26.e6.
17. Jung YW, Lee M, Yim GW, Lee SH, Paek JH, Kwon HY, et al. A randomized prospective study of single-port and four-port approaches for hysterectomy in terms of postoperative pain. Surg Endosc 2011;25:2462–2469.