Total laparoscopic hysterectomy using a percutaneous surgical system: a pilot study towards scarless surgery.
OBJECTIVE
The evolution of minimally invasive surgery has moved beyond reduction of surgical trauma while maintaining adequate efficacy and safety standards. Percuvance™ Percutaneous Surgical System (PSS) instruments represents the last novelty in this panorama. Consisting of less than 3mm laparoscopic shaft introduced percutaneously with an interchangeable 5mm tool installed in place of the needle tip, they combine micro-invasiveness and operative performance.


METHODS
We prospectively collected and retrospectively analyzed data of 10 cases of laparoscopic total hysterectomy with Percuvance™ PSS for benign or early malignant gynecological diseases in order to assess the capability and safety of this new device. Data were recorded in a prospectively designed clinical database including patient demographics characteristics, operative data, intra- and postoperative complications, conversion rate, length of hospital stay and cosmetic outcome.


RESULTS
The reported series consisted of 10 patients undergoing total laparoscopic hysterectomy with a median age of 51.5 years (range 44-72 years) and a median BMI (body mass index) of 25.3 (range 19.7-30.4). All patients had bilateral salpingo-oophorectomy or bilateral salpingectomy and two of them underwent pelvic lymphadenectomy. A median operative time of 67min (range 45-180min) and a median estimated blood loss (EBL) of 50ml (range 10-100ml) were registered. Median PSS introduction time was 5min (range 3-10min). No conversions to standard laparoscopy or laparotomy were required and no intraoperative complications occurred. Discharge was on day 1 in 4 cases, on day 2 in the other 6 cases. All patients conveyed complete satisfaction with the cosmetic result and postoperative pain control. No complications were registered within 30 days after surgery.


CONCLUSIONS
PSS total laparoscopic hysterectomy is safe and feasible with good results in terms of operative time, cosmesis, postoperative pain, recovery and short hospitalization. Further studies are needed to compare PSS total hysterectomy to conventional multi-access laparoscopic and other mini-invasive approaches.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy. Electronic address: cristiano.rossitto@gmail.com.
Cristiano
C
Rossitto
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy.
Salvatore
S
Gueli Alletti
Department of Obstetrics and gynecology, University Hospital, "P.Giaccone", Palermo, Italy.
Stefano
S
Rotolo
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy.
Stefano
S
Cianci
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy.
Giovanni
G
Panico
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy.
Giovanni
G
Scambia
D016063:Blood Loss, Surgical / Q000517:prevention & control; D002921:Cicatrix / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery; D006785:Hospitals, University; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000295:instrumentation; D020706:Laparoscopes / Q000009:adverse effects*; D010535:Laparoscopy / Q000009:adverse effects* / Q000295:instrumentation; D007902:Length of Stay; D008197:Lymph Node Excision / Q000009:adverse effects / Q000295:instrumentation; D008422:Materials Testing; D008875:Middle Aged; D061646:Operative Time; D010052:Ovariectomy / Q000009:adverse effects* / Q000295:instrumentation; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012189:Retrospective Studies; D012384:Rome; D058994:Salpingectomy / Q000009:adverse effects* / Q000295:instrumentation
Laparoscopy; Microlaparoscopy; Minimally invasive surgery; Scar-hidden endoscopic surgery; Scarless surgery