title: Evaluation of laparoendoscopic single-site gynecologic surgery with a multitrocar access system.
abstract: OBJECTIVE
  Laparoendoscopic single-site surgery (LESS) is an ideal approach for gynecologic surgery and yields better cosmetic results. However, a standard umbilical approach with LESS is not appropriate for gynecologic surgery requiring intra-abdominal suturing and dissection requiring traction. Therefore, we have developed a new multitrocar access system for gynecologic LESS. The purpose of this study was to evaluate the efficacy of gynecologic LESS using this access system.
  
  
  METHODS
  This access system consists of one 12-mm trocar, two 5-mm trocars, and a 5-mm flexible laparoscope. Two 5-mm trocars with small port heads were inserted cross-wise on opposite sides of the sleeve of the centrally positioned 12-mm trocar to maintain triangulation. Thirty-eight patients with various gynecologic conditions underwent LESS with this access system. The results of these surgeries were retrospectively compared to those of conventional laparoscopic procedures.
  
  
  RESULTS
  Of the 38 LESS procedures performed with this access system, none was up-converted, converted to an open laparotomy, or required blood transfusion. The Salpingo-oophorectomy with LESS had several benefits, such as no extension of the skin incision of the trocar site and no leakage of the contents of the ovarian cyst into the peritoneal cavity, over that with conventional laparoscopy. A comparison of LESS (11 patients) and conventional laparoscopy (16 patients) for total hysterectomy showed no significant difference in total blood loss (234.0 mL vs. 221.6 mL) or the weight of the resected uterus (276.0 g vs. 285.0 g), although the mean total operative time was greater with LESS (199.0 min vs. 168.5 min).
  
  
  CONCLUSIONS
  Our multitrocar access system is safe and secure, and can be adapted for various gynecologic surgeries involving complicated procedures. LESS with this access system achieves results comparable to those of conventional laparoscopy with 4 ports, although the operative time is longer.
authors.affiliation: Division of Reproductive Medicine, Perinatology and Gynecologic Oncology, Graduate School of Medicine, Nippon Medical School, Japan. masai@nms.ac.jp
authors.forename: Masao
authors.initials: M
authors.lastname: Ichikawa
authors.forename: Shigeo
authors.initials: S
authors.lastname: Akira
authors.forename: Katuya
authors.initials: K
authors.lastname: Mine
authors.forename: Nozomi
authors.initials: N
authors.lastname: Ohuchi
authors.forename: Nao
authors.initials: N
authors.lastname: Iwasaki
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kurose
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Takeshita
mesh_terms: D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods*; D008875:Middle Aged; D013525:Surgical Instruments; D016896:Treatment Outcome