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Rivista di Ostetricia e Ginecologia
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index
Minerva Ginecologica 2017 Mar 06
Copyright © 2017 EDIZIONI MINERVA MEDICA
Is there a role of single port laparoscopy in the treatment of endometriosis?
Angelos DANIILIDIS ✉, Kimon CHATZISTAMATIOU, Efstratios ASSIMAKOPOULOS
2nd University Clinic of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
BACKGROUND: Endometriosis is among the most common benign gynecological conditions, and it affects 6-15% of women of reproductive. During recent decades, minimally invasive surgical techniques, and especially laparoscopy, have gained significant ground concerning the treatment of gynecological disorders. To date, laparoscopy is considered the gold standard for the diagnosis and treatment of endometriosis.
METHODS: Available papers in Pub Med and Scopus data base, written in English language have been used for the current narrative review. Data from all relevant literature regarding single port laparoscopy and treatment of endometriosis have been extracted. The main key words used by the authors for the search were: single port laprosocpy, endometriosis and laparoscopy. Two main authors (AD and KC) performed the data base search and extraction of relevant studies and a third author (EA) consented to the study selection of the 23 relevant papers, consulted and approved the final presentation of the results and conclusions.
RESULTS: To date the LESS (laparoendoscopic single site surgery) surgery technique has been used for a variety of procedures in gynecology as well as for a variety of diagnoses. Thus, adhesiolysis, ovarian endometrioma enucleation and salpingo-oophorectomy can be easily performed using the LESS approach. Novel single site trocars as well as appropriate curved instruments are being designed and produced to facilitate the surgeon utilizing such a demanding technique Single site surgery though, does not seem to have a place to date in the treatment of deep infiltrating endometriosis due to the complicated surgical maneuvers required for the treatment of this condition combined with technical difficulties posed by the loss of triangulation, and the instrument crowding when LESS is implemented. Apart from feasible, LESS has proven to be non-inferior in terms of surgical safety and efficacy, and according to most, but not all, reports, better in terms of cosmetics and post operative body image perception.
CONCLUSIONS: Currently, it has been shown that most of the gynecologic operations are feasible using the LESS approach. So, this approach has a role to play in the treatment of endometriosis too, especially concerning the most common manifestations of the disease. However, more extensive research is required to properly evaluate single port access techniques to conventional minimally invasive ones in the treatment of the different manifestations of endometriosis, concerning short term as well as long term outcomes of the treatment, including the ones associated to fertility
KEY WORDS: Single port laparoscopy - Endometrosis - Laparoscopy