Original Article
Cosmetic Outcomes of Laparoendoscopic Single-Site Hysterectomy Compared With Multi-Port Surgery: Randomized Controlled Trial

https://doi.org/10.1016/j.jmig.2013.01.010Get rights and content

Abstract

Study Objective

To compare cosmetic satisfaction with laparoendoscopic single-site surgery (LESS) compared with multi-port surgery.

Design

Randomized controlled trial (Canadian Task Force classification I).

Setting

University hospital.

Patients

Twenty women who underwent laparoscopically-assisted vaginal hysterectomy (LAVH) via LESS or multi-port surgery.

Interventions

Laparoendoscopic single-site surgery or multi-port surgery.

Measurement and Main Results

Cosmetic satisfaction was assessed using the Body Image Questionnaire at baseline and at 1, 4, and 24 weeks after surgery. Of the 20 LESS procedures, 1 was converted to multi-port surgery because of severe adhesions, and 1 woman assigned to undergo multi-port surgery was lost to follow-up. The 2 surgery groups did not differ in clinical demographic data and surgical results or postoperative pain scores at 12, 24, and 36 hours. Compared with the multi-port group, the LESS group reported significantly higher cosmetic satisfaction at 1, 4, and 24 weeks after surgery (p < .01).

Conclusion

Compared with multi-port surgery, LESS is not only a feasible approach with comparable operative outcomes but also has an advantage insofar as cosmetic outcome.

Section snippets

Study Design and Participants

We conducted the trial between January 2010 and January 2011 at the Samsung Medical Center, a tertiary teaching hospital in Seoul, Korea, and patients who had an indication for hysterectomy were recruited from the obstetrics and gynecology clinic. Patients who had no evidence of gynecologic malignancy on imaging studies and appropriate medical status for laparoscopic surgery (American Society of Anesthesiologists Physical Status classification 1 or 2) were eligible for the study. Major

Characteristics of Trial Participants

Enrollment was from January 2010 through July 2010, and the 6-month follow-up was concluded in January 2011. Of 59 patients who were invited to participate in the study, 5 were ineligible and 14 declined participation; thus, 40 patients were randomized, 20 each to the LESS and multi-port surgery groups (Fig. 1). The characteristics of those who declined participation were similar to those of the study participants (data not shown). After randomization and before surgery, none of the study

Discussion

In the present trial, we found that LESS LAVH was comparable with multi-port LAVH for treatment of gynecologic disease insofar as operative time, estimated blood loss, and perioperative complications. Although LESS demonstrated no benefit in reduction of postoperative pain when compared with multi-port surgery, it was superior to multi-port laparoscopy insofar as cosmetic satisfaction at 1, 4, and 24 weeks after surgery. To our knowledge, this is the first study to evaluate cosmetic

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    Supported by grant CRS 110-09-1 from Samsung Medical Center.

    The authors have no commercial, proprietary, or financial interest in the products and companies described in this article.

    1

    Drs. Song and Cho contributed equally to this article.

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