Giant Ovarian Cysts Treated by Single-Port Laparoscopic Surgery: A Case Series

BackgroundOvarian cysts are very common diseases of the female reproductive system. Giant ovarian cysts refer to the tumors with diameters greater than 10 cm. In recent years, due to the development of clinical diagnosis, imaging modalities, and the improvement of patients’ cognition of the diseases, the occurrence of giant ovarian cysts has become rare. The purpose of this study was to show a new operation method of single-port laparoscopy to treat giant ovarian cysts.MethodsWe report a case series of five patients with giant ovarian cysts who underwent single-port laparoscopic surgery in the gynecology department of the Shengjing Hospital of China Medical University between June 2020 and March 2021. The inclusion criteria were ovarian cysts at least 20 cm in diameter, and cases when the tumor might be malignant were excluded.ResultsThe patients’ mean age was 26.2years. The most common clinical presentation was progressive abdominal distension. Median size of the cysts at imaging was 39.2 cm (range 21–63 cm). All patients underwent single-port laparoscopic surgery, and none of them converted to laparotomy. On final pathological reports, two cysts were serous cystadenomas, and three were mucinous cystadenomas. All patients recovered well and were discharged on time.ConclusionGiant ovarian cysts can be treated by single-port laparoscopic surgery. In addition to the well-known advantages of laparoscopic surgery (e.g., small pelvic interference, fast postoperative recovery), it can also play the role of perfect cosmetic results, which has more advantages for young women.

The Feasibility and Effects in Full Staging Surgery of Endometrial Cancer by Combination of Transumbilical Single-port Laparoscopy and ERAS

BackgroundsTo study the safety, feasibility and aesthetics of transumbilical single port laparoscopic technology combined with accelerated rehabilitation surgery in stage I endometrial cancer staging surgery, and whether the laparoscopic surgery is a factor affecting the prognosis of endometrial cancer. MethodsA total of 93 patients with type I endometrial cancer stage I were enrolled in this study, including 31 cases and 62 cases in the single port and multi-port laparoscopic groups, respectively. Both groups received ERAS technology to compare the intraoperative and postoperative conditions. Subsequently, the medical records of 62 patients who had undergone open surgery were collected, and the survival, recurrence and death of the single port laparoscopic group, the multi-port laparoscopic group and the open surgery group were compared through survival analysis. ResultsThe time of surgery, intraoperative blood loss and fluid infusion volume in the single port group and the multi-port group were significantly less than those of the multi-port group (P<0.05). The single-hole group was better than the open group in terms of rapid postoperative recovery, hospitalization days, incision abdominal incision cometic effect, physical function, physical pain, vitality, and mental health (P<0.05). And there is no significant differences of mortality and recurrence among single port, multi-port and open surgery (P>0.05). Laparoscopic surgery is not a risk factor affecting OS and DFS in patients with endometrial cancer. ConclusionsTransumbilical single port laparoscopy combined with ERAS was safe and feasible for the treatment of stage I endometrial cancer with good cosmetic results and more advantages than multi-port laparoscopy.

Single-port Laparoscopy with Modified Needle Hook-assisted Extracorporeal High Ligation of Hernia Defects (Suwardi’s Technique): An Experience from Single-center Hospital

BACKGROUND: Laparoscopy has long been used for the evaluation of hernia defects on the contralateral side when performing herniated tears in children. In 1997, El Gohary first reported laparoscopic treatment of hernia repair in a female patient. Since then, laparoscopic inguinal hernia ligation has been performed in various medical institutions with a variety of methods including closing the defect intraperitoneally and extracorporeal ligation of the herniated ring defect. CASE PRESENTATION: Data were taken from January 2016 to December 2020 in the Pediatric Surgery Department of Dr. Moewardi General Hospital, Surakarta. A total of 22 cases, consisting of 19 boys and 3 girls aged 1–14 years (mean 5 years), underwent single-port laparoscopy with modified extracorporeal ligation of hernial defects using an epidural needle. From the results of surgery from January 2016 to December 2020, there were 22 patients with a follow-up period of 6 months who were carried out with a single port without the assistance of forceps and hydrodissection with a single-port laparoscopic technique that had been modified extracorporeally using an epidural needle and were able to evaluate the contralateral side. Thus, it shortened the operating period and the patient was able to be discharged 24 h postoperatively without any complications. CONCLUSION: From 22 patients who used single-port technique with modified extracorporeal ligation of hernia defects using epidural needles, the results were shorter operation time, without complications and satisfying cosmetic results.

Reversal of left-sided colostomy utilizing single-port laparoscopy a multicenter European audit and overview of the literature

Background Stoma reversal surgery can result in considerable morbidity and even mortality. Feasibility of utilizing single-port laparoscopy through the stoma fenestration have been shown before. Aim of the present observational study is to evaluate multicenter experiences of single-port reversal of left-sided colostomy (SPRLC) throughout Europe and to provide an overview of available literature on this topic. Methods All patients undergoing SPRLC in four different teaching hospitals throughout Europe are included. Primary outcome was 30-day postoperative complication rate. Secondary outcomes were postoperative length of stay (LOS), single-port success rate and conversion rates. Appraisal of the available literature in PubMed was performed. Results Of 156 SPRLC procedures, 98.7% of them were technically successful and 71.8% were without postoperative complications. No postoperative mortality was encountered. Superficial site infection occurred in 14.7%, anastomotic leakage in 3.9% and major complications in 8.3%. Median LOS was 4.0 days (1–69), single-port success rate was 64.7%, 12.8% and 21.2% (33/154) were converted to an open and multiport laparoscopic procedure, respectively. Literature shows equally favorable results in 131 patients divided over 5 cohorts with morbidity ranging from 0 to 30.4% and mortality from 0 to 2.2% and median LOS of 4–8 days. Conclusion This study confirms the safety, feasibility and favorable results of the use of single-port approach in the reversal of left-sided colostomy in different centers in Europe with laparoscopic experienced colorectal surgeons. The available literature on this topic support and show equally favorable results using single-port laparoscopy for left-sided colostomy reversal surgery.

Giant Ovarian Cysts Treated by Single-Port Laparoscopic Surgery: A Case Series

Background: Ovarian cysts are very common diseases of female reproductive system. Giant ovarian cysts refer to the tumors with diameters greater than 10 cm. In recent years, due to the development of clinical diagnosis, imaging modalities and the improvement of patients' cognition of the diseases, the occurrence of giant ovarian cysts become rare. The purpose of this study was to show a new operation method of single-port laparoscopy to treat giant ovarian cysts. Methods: We report a case series of 5 patients with giant ovarian cysts who underwent single-port laparoscopic surgery in gynecology department, Shengjing Hospital of China Medical University between June 2020 and March 2021. The inclusion criteria were ovarian cysts at least 20 cm in diameters, and cases which the tumor might be malignant were excluded. Results: The patients' mean age was 26.2years. The most common clinical presentation was progressive abdominal distension. Median size of the cysts at imaging was 39.2 cm (range 21–63 cm). All patients underwent single-port laparoscopic surgery, and none of them converted to laparotomy. On final pathological reports, two cysts were serous cystadenomas, and three were mucinous cystadenomas. All patients recovered well and discharged on time. Conclusion: Giant ovarian cysts can be treated by single-port laparoscopic surgery. In addition to the well-known advantages of laparoscopic surgery (e.g., small pelvic interference, fast postoperative recovery), it can also play the role of perfect cosmetic results, which has more advantages for young women.

Comparison of perioperative outcomes of single-port laparoscopy, three-port laparoscopy and conventional laparotomy in removing giant ovarian cysts larger than 15 cm

Background Although conventional laparoscopy has gradually accepted as a surgical treatment for ovarian cancer, reducing the port numbers of laparoscopy still has great challenge for larger ovarian tumors. Thus, this study aims to explore the surgical outcomes of single-port laparoscopy for removing giant ovarian cysts (≥ 15 cm) and compare with laparotomy and three-port laparoscopy. Methods This study enrolled 95 patients with giant ovarian cysts (> 15 cm) who underwent single-port laparoscopy, three-port laparoscopy or laparotomy. Their medical records, perioperative surgical outcomes, and postoperative pain score and complications were analyzed and compared retrospectively. Results Single-port laparoscopy showed better perioperative outcomes and less postoperative pain than three-port laparoscopy and laparotomy. The time between post-surgery and getting out of bed in single-port laparoscopy was significant shorter than that in the laparotomy and three-port laparoscopy (17.53 ± 7.26 vs 29.40 ± 9.57 vs 24.56 ± 7.76, P < 0.01). The length of hospital stay in single-port laparoscopy was significantly shorter than that in other two groups (4.06 ± 0.5 vs 5.46 ± 1.63 vs 4.81 ± 0.83, P < 0.001). In addition, single-port laparoscopy had the lowest postoperative pain scores than in the laparotomy and three-port laparoscopy. There were no significant differences of total hospital cost, postoperative complications and time until gas passing among the three surgical groups. Importantly, in the removal of giant ovarian cysts, the proportion of cyst rupture in single-port laparoscopy was far lower than that in three-port laparoscopy (3.0 vs 22.2%). Conclusions For giant ovarian cysts, single-port laparoscopy is still a safe and efficient technique with the advantages of short operation time, less estimated blood loss, short hospital stay, lower spillage rate, and less postoperative pain.