Transumbilical Single Incision Total Laparoscopic Hysterectomy: Technique and Initial Experience

Ege University Faculty of Medicine, Department of Obstetrics and Gynecology, Izmir, Turkey.
Ginekologia polska (Impact Factor: 0.6). 08/2012; 83(8):581-5. DOI: 10.1016/j.jmig.2010.08.382
Source: PubMed


The aim of the study is to determine the results of our initial experience of 32 cases who underwent single incision total laparoscopic hysterectomy
Thirty-two patients who underwent transumbilical single incision total laparoscopic hysterectomy between March 2009 and February 2011 were reviewed retrospectively at the Department of Obstetrics and Gynecology Ege University Faculty of Medicine, Izmir, Turkey Articulating and rigid instruments, 30 degrees 10 mm telescope, SILS port and advanced bipolar and mechanical energy modalities were used during the procedure. Duration of surgery length of hospital stay mean blood loss and postoperative complications were assessed.
Mean age of patients and mean operation time were 48 years (ranged 42-55) and 108 minutes (ranged 80-180), respectively. In all cases vaginal cuffs were closed with either intracorporeal or extracorporeal separate sutures. There were no intraoperative complications. All patients were discharged within 48 hours postoperatively The mean length of hospital stay and mean blood loss were as 1.6 days (range 1-2) and 45 ml (range 30-100), respectively
Total laparoscopic hysterectomy performed through transumbilical single incision is technically feasible and safe. Development of advanced flexible instrumentation and visualization platform may facilitate this new operative approach.

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    ABSTRACT: The benefits of laparoscopic surgery over open abdominal surgery have been well documented. Efforts to develop strategies that further reduce the size of abdominal incisions and the number of trocars continue to grow. Laparoendoscopic single-site surgery (LESS) is a promising approach that can further enhance cosmetic satisfaction and reduce the risks of laparoscopic surgery. Loss of triangulation, instrument crowding and clashes, poor visualization, and ergonomic problems are the most challenging issues surrounding the use of LESS. The combination of LESS and the robotic system seems to be a promising choice to overcome the technical difficulties of LESS. The da Vinci Single-Site robotic surgical platform is a novel semi-rigid robotic operating system. We therefore present our initial clinical experience of robotic assisted single incision transumbilical total hysterectomy using the novel da Vinci Single-Site Platform.
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    ABSTRACT: Study Objective: To analyze the learning curve of intracorporeal cuff suturing during robotic single-site total hysterectomy. Design: Retrospective study (Canadian Task Force classification Setting: University hospital. Patients: Twenty-four patients with benign indications for hysterectomy. Interventions: Twenty-four patients who underwent robotic single-site total hysterectomy to treat benign indications were included in the study. Surgical procedures were performed by a single surgeon with extensive experience in laparoscopy, using the single-site platform of the da Vinci Surgical System. All vaginal cuffs were closed intracorporeally using semi-rigid single-site instruments. Measurements and Main Results: An exponential learning curve technique was used to analyze the learning curve. The overall mean (SD) vaginal cuff closure time was 23.2 (7) minutes. Learning curve analysis revealed a decrease in vaginal closure time after 14 procedures. Conclusions: An experienced robotic surgeon requires approximately 14 procedures to achieve proficiency in intracorporeal cuff suturing during robotic single-site total hysterectomy. Novel instruments that create perfect triangulation are needed to overcome the current challenges of suturing and to shorten operative time.
    Full-text · Article · Jun 2014 · Journal of Minimally Invasive Gynecology
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