Single-incision laparoscopically assisted vaginal hysterectomy: Operative outcomes and its learning curve

We previously reported on single-incision laparoscopic surgery applied to laparoscopically assisted vaginal hysterectomy (LAVH) cases. We accumulated single-incision LAVH cases to evaluate this operation, including its learning curve. Since July 2009, we planned to perform single-incision LAVH in 50 cases. Operative time, estimated blood loss, weight of resected uterus and additional procedures were recorded and compared to those of conventional multiport, multi-incision LAVH. Additionally, 47 completed single-incision LAVH cases were divided into two groups; the former 24 cases and the latter 23 cases, to estimate its learning curve. Operative outcomes were statistically similar, except that more additional procedures were performed in the conventional LAVH group (27.7% in single-incision vs. 57.5% in the conventional group, P<0.01). We experienced three conversions to multiport surgery from single-incision LAVH, and no conversion case to 'open' total abdominal hysterectomy from conventional LAVH, which was not significantly different (3/50, 6% vs. 0/40, 0%, P=0.12). During the study period, operative time was significantly shortened from 73.0±17.6 min for the former 24 cases to 58.0±12.2 min for the latter 23 cases (P<0.01). There was no significant difference with respect to other operative outcomes between the two groups. Single-incision LAVH can be performed as effectively as conventional multiport LAVH with a short learning curve. We consider that single-incision LAVH may be a promising alternative method for the treatment of certain patients with uterine myomas and adenomyosis as even a less invasive gynecological operation is required without visible scars.