title: Laparoendoscopic single-site surgery with hysterectomy in patients with prior cesarean section: comparison of surgical outcomes with bladder dissection techniques.
abstract: OBJECTIVE
  The aim of this study was to compare operative outcomes from 300 patients who underwent laparoendoscopic single-site surgery (LESS) with hysterectomy (H) according to previous cesarean section and to describe the bladder dissection technique in detail.
  
  
  METHODS
  Retrospective cohort study (Canadian task classification II-2).
  
  
  METHODS
  A university hospital, research hospital, and a tertiary care center.
  
  
  METHODS
  In total, 300 LESS-H procedures were performed for benign gynecologic disease, cervical disease, and endometrial disease at Samsung Medical Center in Seoul, Korea, between May 2008 and February 2012. Patients were categorized into 2 groups according to previous cesarean history: the previous cesarean section group (n = 98) and the no history of previous cesarean section group (n = 202).
  
  
  METHODS
  LESS-H with vaginal or lateral approach for bladder dissection.
  
  
  RESULTS
  Baseline demographics and clinical characteristics, except for age, were generally the same between the 2 groups. The operative outcomes including operative time, uterine weight, estimated blood loss, hemoglobin change, hospital stay, and transfusion rate were not different between the 2 groups. Adhesiolysis was required more in the previous cesarean section group (p = .002). LESS failure requiring additional trocars occurred more often in the previous cesarean section group (p = .041), but the rates of conversion to laparotomy were not different (p = .327). The overall surgical complication rate except transfusion was 2.67% in this study. Two cases of urologic problems with ureter injury or bladder injury were reported in the previous cesarean section group. In the no previous cesarean section group, there were 2 urologic problems.
  
  
  CONCLUSIONS
  LESS-H is a feasible procedure with a lateral approach or vaginal approach for bladder dissection, even in patients with previous cesarean section.
authors: Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: Eun Ju
authors: EJ
authors: Jo
authors: Tae-Joong
authors: TJ
authors: Kim
authors: Yoo-Young
authors: YY
authors: Lee
authors: Chel Hun
authors: CH
authors: Choi
authors: Jeong-Won
authors: JW
authors: Lee
authors: Duk-Soo
authors: DS
authors: Bae
authors: Byoung-Gie
authors: BG
authors: Kim
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002585:Cesarean Section / Q000009:adverse effects; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D061646:Operative Time; D009929:Organ Size; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000209:etiology / Q000601:surgery; D001743:Urinary Bladder / Q000033:anatomy & histology* / Q000601:surgery*
chemical_list: D006454:Hemoglobins