Single port laparoscopic surgery has the advantages of reducing or hiding surgical scars, reducing postoperative pain, and promoting postoperative recovery. With the advancement of technology, the accumulation of experience in single port laparoscopy has gradually enriched. Combining with the experience of vaginal surgery, transvaginal single port laparoscopy has no abdominal incision and thus is more cosmetic ideal, which better practices the concept of minimally invasive surgery. At present, we has established a collaboration group for gynecological single port laparoscopic surgery and a technical group for gynecological single port laparoscopic surgery in China. We have also published two relevant monographs which are the first in this kind all over the world, as well as actively expanded new surgical indications. We carried out relevant training for young surgeons, developed related equipment, as well as developed robotic single port laparoscopic equipment.The purpose of this article is to summarize and prospect the progress of gynecological single port laparoscopic surgery in Chinese Mainland.
Natural orifice transluminal endoscopic surgery (NOTES) is a minimally invasive technique developed in recent years.Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is a minimally invasive gynecologic surgery represented by no scar healing and less postoperative pain. The establishment of vNOTES approach as well as intraperitoneal suture has its own particularity, which is the difficulty of such operations.We will share our experience by this paper.
Pelvic organ prolapse is a common disease in middle-aged and elderly women, which seriously affects their quality of life. In recent years, pelvic floor reconstruction surgery with synthetic mesh has developed rapidly for patients with moderate to severe pelvic floor organ prolapse in multiple sites, repairing and reconstructing pelvic floor structure while restoring the normal anatomy and function of the pelvic floor with the help of mesh, which has a high subjective remission rate and objective cure rate. Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has also developed vigorously in recent years, and this article discusses the application of vNOTES in pelvic floor reconstruction surgery based on the author's previous surgical experience.
In recent years, in the field of gynecologic laparoscopic surgical techniques, suspended pneumoperitoneum-free laparoscopic surgery has shown a prairie fire and rapid development. As an important part of endoscopic surgery, it has become the vanguard of the surgical revolution and is gradually becoming a new mode of surgical treatment in many gynecological procedures. Now, we would like to discuss the ingenious application of this procedure in special populations, analyze the advantages of suspension pneumoperitoneum-free laparoscopy, and discuss its effectiveness and progress of its application in the light of domestic and international reports.
Hysterectomy can be performed through various methods such as traditional laparoscopy, laparoen-doscopic single-site surgery (TU-LESS), and vaginal natural orifice transluminal endoscopic surgery (vNOTES). TU-LESS, due to its hidden incision in the umbilical foramen, has the advantages of beauty and mild postoperative pain. During major hysterectomy, it has the advantage of equal distance between the two sides of the uterus and no significant difference in operation. However, there are problems such as "chopstick effect" and difficulty in precise operation; vNOTES hysterectomy has advantages such as scarless body surface, mild postoperative pain, fast recovery, easy specimen removal, and reduced operator fatigue, but requires comprehensive and rigorous preoperative evaluation. This article focuses on the domestic and international standards for major uterus, the surgical essence of TU-LESS and vNOTES hysterectomy, and the related issues of superiority and inferiority.
Over the past decade, transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has emerged worldwide and is currently the most favored approach among NOTES procedures. It has been widely used in benign gynecological disease such as hysteromyoma and ovarian cyst. Regarding malignant gynecological tumors, such as early-stage endometrial cancer surgery and early-stage cervical cancer surgery, its application is still in the exploratory stage. This article takes vNOTES total hysterectomy with sentinel lymph node dissection for stage I endometrial cancer as an example to elucidate surgical techniques and considerations.
In recent years, transumbilical laparoendoscopic single-site surgery has been widely used in hysteromyomectomy. However, uterine fibroids in special parts (cervix, broad ligament) are often treated with open or multi-port laparoscopic surgery due to their complex surrounding anatomical relationships and high surgical difficulty. With the development of technology and the improvement of operating skills, the removal of uterine fibroids in special parts through transumbilical single-site laparoscopy has been achieved. In this paper, the operative difficulties and indications, preoperative evaluation and preparation, operative key points and techniques of this operation are described.
Single hole laparoscopic technology, as a new type of laparoscopic technology that has developed rapidly in recent years, has the advantages of small trauma, good cosmetic effect, light pain and fast recovery. It is widely used in the diagnosis and treatment of gynaecological benign and malignant diseases. However, it has disadvantages such as difficult operation and long learning curve. Therefore, clinicians continue to put forward new ideas and concepts, explore new surgical modes, and optimise the surgical procedures accordingly, in order to solve the current problems faced by gynaecological single-port laparoscopic surgery. This paper focuses on the conceptual innovation, path optimisation, technical optimisation and procedural optimisation of gynaecological single-port laparoscopic surgery, with a view to further promoting the application of gynaecological single-port laparoscopic technology.
To explore the application of Enhanced Recovery After Surgery (ERAS) in patients undergoing gynecological ovarian cyst surgery and to analyze the factors that affect postoperative recovery time.
Methods
A total of 274 patients who underwent elective gynecological ovarian cyst surgery at the Fourth Ward of the General Gynecology Center of Peking Union Medical College Hospital from Jan. 2021 to May 2021 were included in the study. Their general data and ERAS completion status were collected and analyzed. After conducting a visual analogue scale (VAS) survey using the European fivedimensional Health scale (EQ-5D) instrument, multiple linear regression analysis was performed using SPSS 27.0 statistical software to explore the factors that affect postoperative recovery time.
Results
A total of 274 patients were included in the final statistical analysis. The completion rate of ERAS measures was 77% (65, 85%). Follow-up EQ-5D questionnaire VAS scores and 3 (0, 7) days to recover to a healthy state after surgery. In addition, multiple linear regression analysis revealed that age, VAS score on the second day after surgery, and prevention of postoperative nausea and vomiting had a statistically significant impact on postoperative recovery time (P<0.05).
Conclusions
The application of ERAS in gynecological surgery can accelerate postoperative recovery, shorten postoperative recovery time, and improve the quality of life of patients. Moreover, this study found that age, VAS score on the second day after surgery, and prevention of postoperative nausea and vomiting can shorten the postoperative recovery time, which lays the foundation for the implementation of a simplified version of ERAS in hospitals that cannot fully implement all ERAS management measures.
To compare hysterectomy by transvaginal natural orifice transluminal endoscopic surgery(vNOTES) versus trans-umbilical laparoscopic single-site surgery(TU-LESS) as a minimal invasive technique.
Methods
The women undergoing hysterectomy for benign diseases by vNOTES or TU-LESS from Jan. 2019 to Jun. 2021 in a tertiary hospital in Shanghai were retrospectively analyzed.
Results
361 women were included in our study, with 228 in the vNOTES groups, 129 in the TU-LESS groups and 4 conversions from vNOTES to TU-LESS technique. The operation time of vNOTES group was shorter than TU-LESS group(80.76 min versus 112.09 min; MD -31.34 min ; 95%CI -40.24 to -22.43 min; P<0.001). vNOTES hysterectomy has a quicker gas passage by anus(18.80 versus 36.49 hours, MD -17.68 hours, 95%CI -20.23 to -15.14 hours, P<0.001), and associated with a shorter length of hospital stay (2.31 versus 3.77 days, MD -1.46 days, 95%CI -1.75 to -1.17 days, P<0.001), while with no increase in blood loss during the operation (median 50 versus 50 ml, P=0.25). Besides, the VAS pain score in the 24th hour after the operation was lower(median 0 versus 0.5, P<0.001) in the vNOTES group. Four unique phases of the learning curve were identified using cumulative analysis: the mean operation time of phase I was 82.81±31.45 min ( the initial learning curve of 43 cases), phaseⅡwas 72.48±23.66 min ( the acquisition of command of 91 cases), phase Ⅲ was 103.77±45.69 min (the further learning of 26 cases) and phase Ⅳ was 73.18±26.89 min ( post learning in 68 cases).
Conclusion
vNOTES is non-inferior to TU-LESS as a new minimal invasive procedure for hysterectomy, which also allows patients a faster recovery from surgery and to suffer less pain, and its efficiency and feasibility in large uterine needs further exploring.
To explore the feasibility and learning curve of transumbilical laparoendoscopic single-site total hysterectomy using the "chopstick technique" .
Methods
A retrospective collection of 354 patients from Dec. 2016 to Jun. 2019 at the First Affiliated Hospital of Army Medical University with umbilical single-port or traditional laparoscopic total hysterectomy, including 124 patients with laparoendoscopic single-site total hysterectomy using the "chopstick technique" (TU-LESS group) and 230 patients with traditional laparoscopic total hysterectomy (TL group). The perioperative indexes of the two groups were compared, and the clinical data of 35 consecutive laparoendoscopic single-site total hysterectomy performed by the same physician were retrospectively analyzed; the learning curve was analyzed by CUSUM method.
Results
The basic data were balanced and comparable between the two groups. No statistical differences between the TU-LESS group and TL group: operative time and intraoperative bleeding [131 (102, 155) min vs. 120 (90, 150) min, 100 (100, 200) ml vs. 100 (80, 150) ml]. There was no statistical difference between postoperative exhaust time, visual analogue scale(VAS) score at 12 h and 24 h after operation, and perioperative complications (P>0.05). However, The postoperative hospital stay was shorter in the TU-LESS group than in the TL group, and the difference was statistically significant (P<0.05). The CUSUM analysis showed that the fitting curve reached the peak of 11 surgical cases, which was divided into two stages. Cases 1 to 11 were the first stage (initial learning stage) and cases 12 to 35 were the second stage (consolidation practice stage). The operation time of the two stages was (137.2 ± 37.6) min and (107.3 ± 31.7) min respectively, The operation time in the second stage was significantly shortened, and the difference was statistically significant (P<0.05).
Conclusion
Laparoendoscopic single-site total hysterectomy using the "chopstick technique" has no less perioperative outcomes than traditional laparoscopic surgery. Surgical skills were improved after 11 cases, which was manifested by shortened operation time.
To analyze the comparison of postoperative pain level and incision satisfaction between transumbilical single-port laparoscopic surgery (SPLS) and multi-port laparoscopic surgery (MPLS) in the treatment of benign gynecological diseases.
Methods
The clinical data of 238 patients with benign gynecological diseases admitted to Shijiazhuang Maternity Hospital from Jan. 2020 to Jan. 2021 were analyzed, and the patients were divided into SPLS group (n=119) and MPLS group (n=119) according to the surgical method. The clinical indicators, visual analogue scale (VAS) score, self-assessment anxiety scale (SAS) and satisfaction with incision aesthetics at 12 hours and 24 hours after operation were compared between the two groups.
Results
The anal exhaust time and hospital stay in the SPLS group were shorter than those in the MPLS group, and the VAS scores and SAS scores in the SPLS group at 12 hours and 24 hours after operation were lower than those in the MPLS group (all P<0.05). The overall satisfaction with the aesthetic appearance of the incision in the SPLS group was 97.06% (115/119), which was higher than that in the MPLS group, which was 76.47% (91/119), with a statistically significant difference (P<0.05).
Conclusion
Compared with MPLS, the treatment of benign gynecological diseases with SPLS can reduce postoperative pain and increase treatment satisfaction.
To explore the application of laparoendoscopic single-site surgery technology in the endometrial cancer.
Methods
The clinical data of a patient with endometrial cancer admitted to the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Air Force Medical University in Jun. 2023 were reviewed. The relevant surgical techniques of single-port laparoscopic surgery for endometrial cancer were summarized, and the technical advantages of single-port laparoscopic surgery were evaluated.
Results
The patient underwent single-port laparoscopic comprehensive staging surgery for endometrial cancer. The peritoneum was suspended by suture, and the surgical field was fully exposed.
Conclusion
Laparoendoscopic single-site surgery for endometrial cancer is safe and feasible, which can effectively reduce postoperative pain, shorten hospital stay, and improve patient satisfaction.
Hysterectomy and salpingectomy is one of the common surgical procedures for treating gynecological diseases. Comparing to traditional laparoscopic surgery, transumbilical single-port laparoscopic surgery has the advantages of scar concealment, less pain and paster recovery period. This article discussed the anatomical knowledge and surgical techniques of single-port laparoscopic surgery through the umbilicus during total hysterectomy and salpingectomy.
Method
A retrospective analysis was conducted on one patient with uterine leiomyoma who underwent total hysterectomy and salpingectomy through transumbilical single-port laparoscopic approach at the Gynecology Department of the First Affiliated Hospital of Nanjing Medical University since Nov. 2023. Then, we summarized the anatomical knowledge and surgical techniques of total hysterectomy and salpingectomy through transumbilical single-port laparoscopy, and discussed the recent clinical outcomes.
Results
We successfully performed transumbilical single-port laparoscopic surgery on the patient, which took 2 hours and 5 minutes, and resulted in a blood loss of 50 ml during the operation. The patient recovered well after surgery and was discharged within 3 days. The patient was followed up at the outpatient department one month after surgery, and the umbilical and vaginal incisions healed well.
Conclusion
On the basis of familiarizing with pelvic anatomy, we need to gradually adapt to the practice of transumbilical single-port laparoscopic surgery, adjust the operation steps appropriately, and ultimately achieve the same therapeutic effect as multi-port laparoscopic surgery, then with good cosmetic effects.
Inguinal hernia repair has undergone a revolution from open traditional hernia repair and tension-free hernia repair to laparoscopic and robotic hernia repair. Da Vinci robotic surgical system is a more advanced laparoscopic system. Robotic inguinal hernia repair (RIHR) solves some technical difficulties of laparoscopic inguinal hernia repair (LIHR), and provides a new option for minimally invasive treatment of inguinal hernia. This article reviews the indications and contraindications, surgical procedures, and clinical outcomes of RIHR. The current research results show that the postoperative complication rate and recurrence rate of RIHR are similar to those of LIHR, but the operation time is longer and the cost is higher.
