Laparoendoscopic single-site surgery (LESS) in gynecologic oncology: technique and initial report

Recent reports suggest that laparoendoscopic single-site surgery (LESS), also known as single-port surgery, is technically feasible in treating a variety of disease processes. The purpose of this study was to assess the feasibility of LESS for the surgical treatment of various gynecologic cancers or precancerous conditions through both laparoscopic and robotic-assisted approaches.

A single institution retrospective review of patients treated with LESS on the gynecologic oncology service in 2009 was performed. Patients underwent surgery through a single 2-3 cm umbilical incision with a multi-channel SILS port for laparoscopic cases or a single-channel Gelport for robotic cases on the daVinci Surgical System.

Thirteen patients had LESS surgery performed, nine done laparoscopically and four robotically. Procedures included endometrial cancer staging (n=1), ovarian cancer staging (n=1), retroperitoneal pelvic lymph node dissection (n=1), risk-reducing extrafascial hysterectomy/bilateral salpingo-oophorectomy (BSO, n=2) and BSO alone (n=5), and an ovarian cystectomy (n=1) and BSO (n=2) for complex adnexal masses. Median patient age and BMI were 47 years and 28, respectively. Median operating time was 65 min. All procedures were successfully performed via a single incision and no post-operative complications occurred. The majority of patients required no narcotics post-operatively.

We present the first series of laparoendoscopic single-site surgery for the treatment of various gynecologic oncology conditions. LESS is feasible in select patients by laparoscopic or robotic-assisted techniques. Further studies are needed to better define the ideal gynecologic procedures for single-site surgery and to assess the benefits of LESS compared with more conventional minimally invasive approaches.