Laparoendoscopic single-site versus conventional laparoscopic-assisted vaginal hysterectomy for benign or pre-invasive uterine disease

Background: The aim of this study was to compare the surgical outcomes of laparoendoscopic single-site (LESS) versus conventional laparoscopic-assisted vaginal hysterectomy (LAVH) in patients with benign or pre-invasive uterine disease.

Methods: The surgical outcomes of patients who had tried either LESS or conventional LAVH for benign or pre-invasive uterine disease were retrospectively reviewed and compared. Postoperative pain was assessed using the Visual Analog Pain Scale every 8 h after surgery.

Results: In total, 503 and 543 patients tried LESS and conventional LAVH, respectively. Additional ports were required in thirteen (2.6 %) and one (0.2 %) LESS and conventional LAVH patients, respectively (P = 0.001). One patient in each group required conversion to laparotomy (0.2 vs. 0.2 %, P = 0.957). The demographic and clinicopathologic characteristics were similar between groups. There was no difference in operating time, estimated blood loss, perioperative hemoglobin level change, transfusion requirement, and perioperative complications. However, the LESS LAVH group showed a reduced length of postoperative hospital stay (2.1 vs. 2.5 days, P < 0.001), an increased percentage of patients discharged within 2 days of surgery (88.9 vs. 73.7 %, P < 0.001), significantly lower pain scores at 8, 16, and 24 h after surgery, and a decreased percentage of patients requiring additional analgesics (33.4 vs. 61.3 %, P < 0.001).

Conclusions: LESS LAVH demonstrated comparable technical feasibility to conventional LAVH and was associated with less postoperative pain, a decreased need for postoperative analgesics, and decreased length of postoperative hospital stay.