title: Single-incision multiport laparoscopy versus multichannel-tipped single port laparoscopy in gynecologic surgery: outcomes and benefits.
abstract: OBJECTIVE
  To estimate the feasibility and safety of single-incision multiport laparoscopy (SIMPL) used in patients who underwent laparoendoscopic single-site surgery (LESS) for gynecologic disease, and the cosmetic outcome and economic benefit compared with multichannel-tipped single port laparoscopy (MSPL).
  
  
  METHODS
  We underwent LESS via a single 2.5- to 3.0-cm umbilical incision with the Single-Incision Multiport Laparoscopic Surgery Trocar available on the market, briefly named MSPL. Since January 2014, we improved the procedure and named SIMPL. In SIMPL group, two traditional laparoscopic trocar (diameter=5 mm) and one mini-laparoscopic trocar (diameter =3 mm) were inserted into the peritoneum separately through a single 1.5- to 1.8-cm umbilical transcutaneous incision. Subject demographics and clinical variables were collected and perioperative outcomes analyzed. In addition, the size of umbilicus was measured in all patients prior to the operation and the levels of cosmetic satisfaction were evaluated at 4 weeks after surgery.
  
  
  RESULTS
  From January 2014 to December 2014, there were 32 patients who underwent SIMPL for ovarian cystectomy. Hospital cost was significantly lower in SIMPL group compared with MSPL group (RMB 10207.0 vs 17973.7 yuan), P<0.001. Compared with MSPL group, the SIMPL group reported significantly higher cosmetic satisfaction at 4 weeks afer surgery (P<0.1). Besides, the SIMPL procedures performed in benign gynecologic surgery were myomectomy (n=8), salpingpoophorectomy (n=2), salpingectomy (n=5), adhesiolysis and fimbrioplasty (n=32), ovarian drilling (n=3), salpingotomy for ectopic pregnancy (n=3). All surgeries were completed successfully without conversion to the traditional laparoscopic approach. Two postoperative complications occurred were delay healing of umbilicus incision after myomectomy. The cosmetic satisfactory rate was 100%.
  
  
  CONCLUSIONS
  According to our experience, SIMPL is safe and efficient for simple gynecologic operation, with lower cost and better cosmetic results than MSPL. Beyond cosmetic and economic results, further randomized studies are needed to identify a possible benefit.
authors.affiliation: Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University Shanghai 200090, China.
authors.forename: Mingzhi
authors.initials: M
authors.lastname: Zhao
authors.affiliation: Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University Shanghai 200090, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University Shanghai 200090, China.
authors.forename: Keqin
authors.initials: K
authors.lastname: Hua
authors.affiliation: Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University Shanghai 200090, China.
authors.forename: Zhiling
authors.initials: Z
authors.lastname: Zhu
authors.affiliation: Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University Shanghai 200090, China.
authors.forename: Changdong
authors.initials: C
authors.lastname: Hu
keywords: Laparoendoscopic single-site surgery (LESS); benign gynecologic disease; multichannel-tipped single port laparoscopy (MSPL); single-incision multiport laparoscopy (SIMPL)