Single Incision Laparoscopic Surgery is Feasible, Safe in Gynecology

A prospective case series analysis has shown that single incision laparoscopic surgery (SILS) is a technique that is both feasible and safe for the surgical management of a variety of gynecological conditions.¹

The latest advances in minimally invasive surgery involve the use of flexible endoscopes and articulating instruments that enable surgeons to perform SILS, which is also called single-port laparoscopic surgery. This surgical technique is well-reported in both general and urological surgery, but there has been a lack of studies on the use of SILS in gynecological surgery.

To evaluate the feasibility, safety, and cosmetic and clinical outcomes of SILS in gynecology, researchers identified 105 women who had a scheduled SILS gynecological procedure. Data for operative time, estimated blood loss, complications, need for additional ports, and hospital stay were collected, and reports of post-operative pain and cosmetic outcomes were documented. Of the 105 women, 21 did not have a SILS procedure because of a variety of reasons, one of which was because the facility did not have the required equipment, explained the study authors. Of the remaining 84 women who underwent SILS, 60 had endometriosis, 13 had adhesions, 5 needed a hysterectomy, 2 required mesh sacrohysteropexy, and 4 needed ovarian cystectomy.

Because of surgical difficulties, additional ports were needed in 4 of the 84 SILS cases. Uterine perforation occurred in 1 patient during surgery. After surgery, 6 women experienced wound infections, and 1 woman had a vault hematoma. The average procedure time was 60 minutes for the mesh sacrohysteropexy, 55 minutes for excision of endometriosis, 150 minutes for hysterectomy, 62 minutes for division of adhesions, and 40 minutes for ovarian cystectomy. Patients were highly satisfied with the procedure because of both improved cosmetic outcomes and reduced need for pain medication after surgery, reported the study authors.

This latest advancement in minimally invasive surgery significantly reduces patient recovery time-from 6 to 8 weeks for a traditional inpatient abdominal hysterectomy to approximately 1 week for a SILS hysterectomy.² The multi-channel ports used in SILS allow for the placement of several instruments through a single 2-centimeter incision, usually hidden in the umbilicus. It has been recommended that for surgeons new to this technique, they should start with adnexal surgery and limit their patient selection to those with a low body mass index, no history of abdominal or pelvic surgery, and a uterine size smaller than 12 weeks.³

Pertinent Point:
- The cosmetic benefits of SILS are well-established, but the clinical benefits are a shorter recovery time and reduced need for analgesics postoperatively.
 

References:

1. Behnia-Willison F, Foroughinia L, Sina M, McChesney P. Single incision laparoscopic surgery (SILS) in gynaecology: feasibility and operative outcomes. Aust N Z J Obstet Gynaecol. 2012;52:366-370.
2. Minimally Invasive Surgery Center for Women. Available at: http://iuhealth.org/west/minimally-invasive-surgery/. Accessed September 19, 2012.
3. Atkin RP, Nimaroff ML, Bhavsar V. Applying single-incision laparoscopic surgery to gyn practice: what’s involved. OBG Management. 2011;23(4):28-36.