Single-port access laparoscopic-assisted vaginal hysterectomy: a novel method with a wound retractor and a glove.
OBJECTIVE
To present our initial experience with single port-access laparoscopic-assisted vaginal hysterectomy (SPA-LAVH) by use of a wound retractor and a glove.


METHODS
Continuing, prospective study (Canadian Task Force classification II-3).


METHODS
University teaching, research hospital, and a tertiary care center.


METHODS
We performed the SPA-LAVH in 24 patients from May 6, 2008, through October 8, 2008.


METHODS
All cases of SPA-LAVH were performed by a single surgeon (T. J. K.).


RESULTS
We analyzed the data to determine the outcome of SPA-LAVH and compared the initial 10 cases (group A) and the latter 14 cases (group B) to consider the learning curve. Median and range are used to describe non-normal data. A total of 24 consecutive patients have undergone SPA-LAVH, for benign gynecologic conditions, including 16 uterine myomas and 8 cases of adenomyosis, regardless of body mass index or previous abdominal or pelvic surgery. All cases but 3 were performed exclusively through a single port. The median operative time, weight of the uterus, and estimated blood loss were 119 minutes (range 90 to 255 minutes), 347 g (range 225 to 732 g), and 400 mL (range 100 to 1000 mL), respectively. The decline in hemoglobin from before surgery to postoperative day 1 was from 0.7 to 4.3 g/dL, with a median of 2.05 g/dL. The median hospital stay (postoperative day) was 3 days (range 3 to 7). When we compared the operative outcomes between the 2 groups, there was a tendency toward a decreased operative time in group B, although the difference was not significant. However, there was a significant decrease in the estimated blood loss and hospital stay in group B (p = .00, = .04, respectively).


CONCLUSIONS
The SPA-LAVH was safe and effective, and the procedure could be learned over a short period of time. Additional experience and continued investigation are warranted.
Lee
Yoo-Young
YY
Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea.
Kim
Tae-Joong
TJ
Kim
Chul Jung
CJ
Kang
Heeseok
H
Choi
Chel Hun
CH
Lee
Jeong-Won
JW
Kim
Byoung-Gie
BG
Lee
Je-Ho
JH
Bae
Duk-Soo
DS
D000328:Adult; D005260:Female; D005932:Gloves, Surgical; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D010865:Pilot Projects; D011028:Pneumoperitoneum, Artificial / Q000379:methods; D013525:Surgical Instruments