Laparoscopic single-port versus minilaparoscopic histerectomy: an International Study.

Objectives: laparoendoscopic single-site surgery (LESS) and mini-laparoscopic surgery (Mini-LPS) have been carried out with comparable results to conventional laparoscopy. However, there is scarce data on comparison between them. Our main objective was to compare LESS and Mini-LPS in terms of surgical time, postoperative pain and hospital stay in patients undergoing simple hysterectomy for a benign condition.Design: this is a retrospective international multicentric study carried out in two Spanish and three Italian centers. Data from 161 patients operated for hysterectomy for a benign condition were collected between January 1st, 2010 and December 31st, 2015. 104 (64.6%) patients were operated by LESS and 57 (35.4%) by Mini-LPS. Methods: we collected patients ' clinic-pathologic characteristics and perioperative outcomes. The main variables of the study were surgical time, time to oral analgesia and the hospital stay. The two comparison groups in the study included patients operated for hysterectomy for a benign condition by LESS or Mini-LPS. The decision to perform the type of procedure was at surgeon ' s discretion, mainly based on surgical skills and experience of the center. All data was collected retrospectively by an encrypted on-line platform.Results: Median surgical time was significantly longer in LESS group compared to Mini-LPS group (120 vs. 75 minutes, respectively; p<.001). Moreover, longer median hospital stay was observed in LESS group compared to Mini-LPS (48 vs. 36 hours, respectively; p<.001). Conversion of the technique to conventional LPS was performed in 4 (2.5%) patients, all of them in the Mini-LPS group (p=.015).Limitations: it is a retrospective study with the biases that this implies. Furthermore, some variables have been incompletely registered in the database, which implies loss of information in some cases. This is a non-randomized study, since the decision to intervene by one technique or another was made by the surgeon, which generated 2 non-homogeneous groups in terms of number of patients. On the other hand, all the patients operated on for Mini-LPS belong to the same center, which can make these results surgeon and center dependent.Conclusions: significant shorter surgical time and shorter hospital stay was observed in patients undergoing Mini-LPS hysterectomy compared to LESS technique; however, intraoperative complications related to instrumentation flaws were higher in mini-LPS group that required conversion to standard laparoscopy in all cases. Both ultra-minimally invasive techniques seems to be safe for performing hysterectomy for benign condition and emphasize the importance of surgical training to adapt them to our current practice.

Automated summary

This retrospective multicentric study compared laparoendoscopic single-site surgery (LESS) and mini-laparoscopic surgery (Mini-LPS) in terms of surgical time, postoperative pain, and hospital stay for patients undergoing simple hysterectomy for a benign condition. The results showed shorter surgical time and hospital stay in the Mini-LPS group compared to the LESS group. However, the Mini-LPS group had a higher rate of conversion to standard laparoscopy due to instrumentation flaws. Both ultra-minimally invasive techniques were found to be safe for performing hysterectomy for a benign condition.