Laparoscopic Single Site Hysterectomy through an 11mm Bluntly Created Incision
Objective: To demonstrate the feasibility of a single port laparoscopic hysterectomy technique performed through a single smaller umbilical incision than has been described. Design: A narrated video demonstration of the surgical procedure. Material and Methods: Multiple authors have documented the feasibility of single incision laparoscopic hysterectomy. Many authors have commented that the idea, although novel, does not significantly improve intraoperative pain, recovery or improve cosmesis. The most commonly used system is a robotic assisted single port system. All systems, to the knowledge of the authors, require incisions greater than 15mm in the umbilicus. We examined different single port systems and combined available instrumentation to create a feasible, repeatable technique for performing a laparoscopic single site hysterectomy using only an 11mm umbilical incision, that is created with a blunt laparoscopic trochar. We have explained the technique a video for reproducibility. Results: A 32 year-old woman with endometriosis, adenomyosis and chronic pelvic pain with recurrent ovarian cysts presented for laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Patient had previously tried more conservative surgeries and medical treatments including a 6 month course of luprolide and multiple surgeries for fulgaration. The patient completed her desired childbearing and requested definite treatment. The patient had a history of prior BTL and one prior cesarean section. The total operative time was 38 minutes, and the estimated blood loss was 100cc. The recovery was uneventful. Conclusions: Our described technique is a feasible, reproducible procedure for hysterectomy and may improve cosmesis and postoperative pain over traditional laparoscopic and single port techniques.