Single-port access laparoscopy-assisted vaginal hysterectomy: our initial experiences with 100 cases

Abstract

Objectives. To present our initial experiences with laparoscopically assisted vaginal hysterectomy performed using homemade transumbilical single-port system. Materials and Methods. We reviewed the medical records of one hundred patients who underwent single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH). SPA-LAVH was performed with homemade single port system and conventional rigid laparoscopic instruments. Results. All procedures were successfully completed through the single-port system and vagina without need for extraumbilical puncture or conversion to laparotomy. The median patient age was 48.2 ± 6.5 years. Thirty-three patients had history of past abdominopelvic surgery. The median total operative time, largest dimension of the uterus, and weight of the uterus were 73.1 ± 24.6 min, 10.5 ± 2.1 cm, and 300.8 ± 192.5 gram, respectively. The median decline in the hemoglobin from before surgery to postoperative day 1 was 1.8 ± 0.9 g/dL. Bladder injury in occurred one patient who was repaired through intraoperative laparoscopic suture. The postoperative course was uneventful in most patients except for three who had a transient paralytic ileus, five who had pelvic hematoma, but they were recovered following conservative managements. No port-related complications were noted, and the cosmetic results were excellent. Conclusions. SPA-LAVH is technically safe procedure, and the homemade single-port system offers reliable access for single-port surgery.

Figures

Figure 1

SPA-LAVH for adenomyosis with coexisting myoma (46-year-old woman). (a) Transumbilical single route for surgery using Alexis wound retractor. Distal ring was loaded within the intraperitoneal space and tightly turned inside out of the proximal ring, creating an effective seal and a wider opening of the single-port incision by connecting retractable sleeve between the distal and proximal rings. The fascial edges were tagged with suture for traction prior to port system installation; this was useful for fascial closure at the end of the procedure. (b) Homemade, three-channel, single-port system using the Alexis wound retractor and a surgical glove. A sterile surgical glove was placed over the proximal ring and fixed tightly, and three trocars were inserted through surgical glove with cut edges of the distal fingertips and tied with an elastic string. Varying the height of the trocar head minimized clashing of the bulkiest portion of the trocar head and the instrumental grip (the external handle) extracorporeally overlapping. (c) Laparoscopic finding: huge uterine leiomyoma with coexisting adenomyosis. The largest dimension of the uterus was 15 cm. (d) Photograph showing an extirpated uterus. The weight of the uterus was 750 g. Compared with 50 mL disposable syringe. (e,f) Photograph showing the postoperative umbilical skin wound (postoperative day 1 and 4 weeks).