Minilaparoscopic Single-Site Total Hysterectomy.

Abstract

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. 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. 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. 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.