Safety and feasibility of laparoendoscopic single-site surgery in the management of giant ovarian cysts

Objective To investigate the safety and feasibility of laparoendoscopic single-site surgery (LESS) in the treatment of giant ovarian cysts. Methods A total of 76 patients with giant ovarian cyst (diameter ≥ 10 cm) who received surgical treatment in our hospital from January 2018 to May 2021 were divided into experimental cohort (single-port laparoscopic cohort) (n = 30) and control cohort (traditional laparoscopic cohort) (n = 46).The operation time, intraoperative blood loss, intraoperative cyst fluid spillage rate, application of postoperative analgesic drugs, postoperative first anus exhaust time, incidence rate of perioperative complications, length of postoperative hospital stay and other clinical indicators were summarized and analyzed between the two cohorts. Results The LESS cohorts had an earlier onset of age[ (27.6 ± 8.4) ,years of age], shorter of operation time [(82.2 ± 16.0)min], less of intraoperative blood loss [( 17.5 (10-22.5) ml)] as compared with traditional laparoscopic cohort[ (40.9 ± 15.5 )years of age, (102.7 ± 26.2)min, (20 (18.7–35) )m,P ༜ 0.05]. The first postoperative exhaust time,the rate of postoperative analgesic drugs, incidence rate of perioperative complications and postoperative hospital stay in two cohorts were in the similar line. Conclusion After adequate evaluation and screening of patients, the size of ovarian cysts cannot be the reason for refusing LESS surgery. It is safe and feasible for clinical promotion in the management of giant ovarian cysts.

Comparison of a new gasless method and the conventional CO2 pneumoperitoneum method in laparoendoscopic single-site cholecystectomy: a prospective randomized clinical trial

To avoid CO2 pneumoperitoneum-associated cardiopulmonary side-effects during conventional laparoscopic surgeries, we have developed a gasless laparoscopic operation field formation (LOFF) device for laparoendoscopic single-site surgery. The aim of this study is to analyze the safety and efficacy of the LOFF device for laparoendoscopic single-site cholecystectomy and to verify its advantage of avoiding CO2 pneumoperitoneum-associated complications. In this prospective, randomized, observer-blinded clinical trial, eligible participants were randomized in a 1:1 ratio to undergo either conventional CO2 pneumoperitoneum assisted laparoendoscopic single-site cholecystectomy (LESS) or the new gasless LOFF device assisted laparoendoscopic single-site cholecystectomy (LOFF-LESS). Outcomes including intra-operative respiratory and hemodynamic parameters, operation time, conversion rate, complication rate, et al were compared between the two groups. A total of 100 patients were randomized to the LESS group [n = 50; mean (SD) age, 49.5 (13.9) years; 24 (48.0%) women] and the LOFF-LESS group [n = 50, mean (SD) age, 47.4 (13.3) years; 27 (54.0%) women]. Compared with the LOFF-LESS group, the LESS group witnessed significant fluctuations in intra-operative respiratory and hemodynamic parameters. The tracheal extubation time of the LESS group was significantly longer (P = 0.001). The gasless LOFF device is safe and feasible for simple laparoscopic cholecystectomy and has a predominance of avoiding CO2 pneumoperitoneum-associated cardiopulmonary side-effects. Trial registration number: ChiCTR2000033702 Graphic abstract

Laparoendoscopic Single Site Hysterectomy: Literature Review and Procedure Description

Laparoendoscopic single site surgery (LESS) refers to a spectrum of surgical techniques that allow the performance of laparoscopic surgery through consolidation of all ports into one surgical incision. LESS has emerged as a potentially less invasive alternative to multiport laparoscopy and in the last year in gynecology; hence, this approach has been largely applied for selective indications to perform total hysterectomy. We performed a literature review on single site hysterectomy and described indications and technique, highlighting practical problems, pointers, limitations and recent technical development as robotic assistance.

Chopstick technique used in laparoendoscopic single site radical hysterectomy for early stage cervical cancer

Laparoendoscopic single-site surgery (LESS) further minimizes the invasiveness of traditional laparoscopic surgery. However, the "chopstick" effect caused by the parallel arrangement of the instruments in the umbilicus is considered an obstacle indelicate operations. The purpose of this study was to introduce a new technique characterized by a double fulcrum formed by instruments, named the "chopstick" technique, which facilitates the expedient accomplishment of complicated surgeries such as LESS radical hysterectomy (LESS-RH). Seventy-three patients who underwent LESS-RH using the "chopstick" technique were retrospectively analyzed. The procedure was performed successfully in 72 patients. The median operative duration was 225 min, and the median intraoperative blood loss was 200 ml. Among the operations in the first 20 patients, intraoperative vascular injuries and bladder injury occurred in two patients and were repaired by LESS. Patients responded positively regarding minimal postoperative pain control. The score of satisfaction with the cosmetic outcome expressed by the patients was eight at discharge and nine 30 days later. In conclusion, this study presents the feasibility of accomplishing complicated procedures, such as radical hysterectomy, by LESS using the “chopstick” technique. This approach provides more options for both selected patients and surgeons.