Single-port-access, hand-assisted laparoscopic surgery for benign large adnexal tumors versus single-port pure laparoscopic surgery for adnexal tumors.

Roh, Hyun-Jin; Lee, Soo-Jeong; Ahn, Jun-Woo; Kwon, Yong-Soon; Cho, Hyun-Jin; Kim, Dae-Yeon

BACKGROUND Single-port-access hand-assisted laparoscopic surgery (SPA-HALS) is a method intended to provide surgical outcomes with advantages similar to those of SPA-pure laparoscopic surgery (SPA-PLS) for patients with benign large adnexal tumors and to reduce the spillage of tumor contents. This study aimed to assess the feasibility and methodology of SPA-HALS for benign large adnexal tumors and to compare the surgical outcomes of SPA-HALS and SPA-PLS performed by a single surgeon (H.-J. R.). METHODS Between March 2009 and February 2011, 139 patients underwent SPA adnexal surgery. The SPA-PLS procedure was performed for 96 candidates for conventional laparoscopic adnexal surgery, whereas SPA-HALS was performed for 43 patients with large adnexal tumors. The patient demographics and surgical outcomes of these two groups were compared. RESULTS The median adnexal tumor size was larger in the patients who underwent SPA-HALS than in those who underwent SPA-PLS (10.9 vs. 6.3 cm; p < 0.001). Spillage occurred for four patients in the SPA-HALS group (10.3%) compared with 33 patients in the SPA-PLS group (31.3%) (p = 0.005). The relative risk of spillage was 4.43 times higher in the SPA-PLS than in the SPA-HALS group (95% confidence interval [CI], 1.45-13.53). Adnexa-conserving surgery was significantly more frequent in the SPA-HALS group than in the SPA-PLS group (76.7% vs. 43.8%; p < 0.001). Additional procedures were less frequent in the SPA-HALS group (16.3% vs. 33.3%, p = 0.043). The median estimated blood loss was significantly lower in the SPA-HALS group (50 vs. 105 ml; p = 0.001). The two groups did not differ significantly in median operation time (75 vs. 70 min), complication rate (0% vs. 3.1%), or postoperative hospital stay (2 vs. 2 days). CONCLUSION The findings showed that SPA-HALS extracorporeal adnexal surgery allows for thorough evaluation of peritoneal structure and complete surgery of benign large adnexal tumors while retaining the advantages of SPA adnexal surgery. Furthermore, this technique may reduce the intraperitoneal spillage rate for benign large adnexal tumors.