Single-port access subtotal laparoscopic hysterectomy: a prospective case-control study

Study Objective: The objective was to evaluate the perioperative outcomes, safety, and patient acceptance of single-port access laparoscopic subtotal hysterectomy (SPAL-SH) in comparison with conventional multiport access laparoscopic subtotal hysterectomy (MPAL-SH). Design: Case-control study. Canadian Task Force Classification II-2. Setting: The study was conducted at university hospitals in Cagliari, Italy, and Rouen, France. Patients: Sixty-one women with metrorrhagia, abnormal uterine bleeding with uterine myomas, or symptomatic adenomyosis were included in the study. Interventions: Thirty-one patients underwent SPAL-SH, and 30 patients underwent conventional MPAL-SH. Measurements and Main Results:We analyzed the data to compare the outcomes of SPAL-SH versus MPAL-SH. Patients in the SPAL-SH group had longer operative times than those in the MPAL-SH group (p <.001) but shorter hospital stays (p <.001). Postoperative pain immediately after surgery, after 6 hours, and after 24 hours were lower in the SPAL-SH group (p <.001). The SPAL-SH group reported significantly higher cosmetic satisfaction at 1, 4, and 24 weeks after surgery (p <.01). Conclusion:We conclude that SPAL-SH is a feasible and safe alternative to standard MPAL-SH in selected patients. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. In addition, SPAL-SH has a definite benefit in relation to body image and cosmesis.