title: Minilaparoscopic Single-Site Total Hysterectomy.
abstract: BACKGROUND
  Laparoendoscopic single-site surgery and minilaparoscopy (ie, the use of 3-mm instruments) represent two of the most recent advances in ultraminimally invasive surgery. We have combined these two techniques and transvaginal cuff closure to develop a technique for the performance of single-incision, transumbilical, minilaparoscopic hysterectomy.
  
  
  METHODS
  The complete endoscopic detachment of the uterus from its supports and vessels is performed using only two 3-mm minilaparoscopic trocars, both inserted in the umbilicus, with the aid of a uterine manipulator. The procedure was completed with transvaginal extraction of the uterus and transvaginal closure of the vaginal cuff.
  
  
  RESULTS
  We performed 20 minilaparoscopic single-site hysterectomies. One (5%) conversion to conventional minilaparoscopic hysterectomy was needed as a result of adhesions. No intraoperative or postoperative complications occurred and all women were discharged home within 30 hours after surgery. Postsurgical pain (measured with a 0-10 visual analog scale administered by an independent observer postoperatively) was very low: 2 (1-3), 2 (1-3), and 0 (0-2) at 1, 3, and 8 hours postoperatively, respectively.
  
  
  CONCLUSIONS
  Single-site total minilaparoscopic hysterectomy using only two 3-mm ports inserted through the umbilicus is feasible and further reduces the incisional trauma of surgery.
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Serati
authors.forename: Jvan
authors.initials: J
authors.lastname: Casarin
authors.forename: Stefano
authors.initials: S
authors.lastname: Uccella
mesh_terms: D000328:Adult; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000295:instrumentation / Q000379:methods*; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010149:Postoperative Pain