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Minerva Obstetrics and Gynecology 2022 October;74(5):434-43

DOI: 10.23736/S2724-606X.21.04957-5


lingua: Inglese

Is it time to leave multi- for single-port laparoscopy in benign gynecologic surgery? A systematic review of randomized clinical trials

Marta BONOLLO 1 , Serena BELLAMINUTTI 1, Maria L. GASPARRI 1, 2, Andrea PAPADIA 1, 2

1 Service of Gynecology and Obstetrics, Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, Lugano, Switzerland; 2 Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland

INTRODUCTION: Conventionally, laparoscopic surgery in gynecology requires multiple accesses in the abdominal cavity. Laparo-endoscopic single-site surgery (LESS) is a more recent technique consisting in a laparoscopy in which the abdominal cavity is reached by a single umbilical incision. The aim of this systematic review is to summarize and comment the benefits and drawbacks in benign gynecological surgeries, including hysterectomy, myomectomy, and adnexal surgery, by LESS and conventional multiport laparoscopy (MPL), respectively.
EVIDENCE ACQUISITION: A systematic review following the Preferred Reporting Items for Systematic reviews and Randomized Control Trials (PRISMA) was performed by researching articles in PubMed, Medline, Web of Science, and Cochrane library. The terms searched were “single port laparoscopy” or “laparo-endoscopic single site surgery” or “single site laparoscopy” or “single-incision laparoscopic surgery” and “hysterectomy,” or “myomectomy,” or “adnexal surgery”. Only randomized-controlled trials (RCTs) comparing LESS and MPL in benign gynecology were included.
EVIDENCE SYNTHESIS: Thirteen RCTs including 1088 women undergoing gynecological surgery for benign disease through LESS versus MPL were included in the analysis of which 620 underwent hysterectomy, 154 myomectomy, 314 adnexal surgery. LESS approach was performed in 531/1088 (48.8%) procedures. All studies compared the surgical outcomes for length of operative time, hemoglobin drop, length of hospitalization, rate of conversion, postoperative pain, intra and postoperative complications. For hysterectomy, a longer operating time and a higher conversion rate were shown in the LESS group, but no significant differences were found for the other outcomes. For myomectomy, the only significant difference was found for a higher conversion rate in the LESS group. For adnexal surgery, no significant differences were found. Globally there was no difference in pain based on the Visual Analog Scale Score. Cosmetic outcome was reported in 6/13 of the studies included, 4/6 demonstrated a superior cosmetic satisfaction in the LESS group.
CONCLUSIONS: Despite cosmetic result is intuitively the main advantage for LESS technique, current evidence does not seem to demonstrate a clear superiority of LESS compared to MPL in benign gynecological surgery.

KEY WORDS: Gynecologic surgical procedures; Laparoscopy; Minimally invasive surgical procedures

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