Laparoendoscopic single-site (LESS) surgery in patients with benign adnexal disease.

Escobar, Pedro F; Bedaiwy, Mohamed A; Fader, Amanda Nickles; Falcone, Tommaso

OBJECTIVE To present our initial experience in laparoscopic surgery for benign adnexal disease performed exclusively through an umbilical incision using a single three-channel port and flexible laparoscopic instrumentation. DESIGN Case report. SETTING Tertiary-care referral center. PATIENT(S) Since November, 2008, we have performed single-port laparoscopic surgery in nine patients diagnosed with benign adnexal disease. Patients with adnexal masses or endometriosis and a body mass index of <35 kg/m(2) were selected. INTERVENTION(S) Laparoendoscopic single-site (LESS) surgery. In each case, a multichannel port was inserted into the peritoneum through a 1.5-2.0-centimeter umbilical incision. MAIN OUTCOME MEASURES Feasibility, postoperative pain score, age, BMI, estimated blood loss. RESULT(S) Eight of nine cases were completed successfully, without conversion to a standard laparoscopic approach or to laparotomy. An additional 3 mm extraumbilical port was required in one patient with stage 4 endometriosis. Seven out of nine patients had earlier abdominal surgery. The operative blood loss ranged from minimal to 75 mL. Duration of hospital stay was <24 hours in all cases. Minimal use of postoperative narcotics was required, and no intraoperative complications occurred. CONCLUSION(S) The LESS surgery for benign adnexal disease is feasible in patients with or without earlier surgery. Additional investigation is needed to evaluate the safety and long-term outcomes of this new approach.