Two-phase laparoendoscopic single-site cervical ligament-sparing hysterectomy: An initial experience

Area of Science:

• Minimally Invasive Gynecologic Surgery
• Laparoscopic Surgery
• Hysterectomy Techniques

Background:

• Hysterectomy is a common gynecologic procedure.
• Minimally invasive approaches aim to reduce patient morbidity.
• Laparoendoscopic single-site surgery (LESS) offers potential cosmetic and recovery benefits.

Purpose of the Study:

• To evaluate the initial experience and short-term outcomes of a novel two-phase LESS cervical ligament-sparing hysterectomy (LESS-CLSH).
• To assess the feasibility and safety of LESS-CLSH in a cohort of 40 women.

Main Methods:

• Retrospective case study of 40 women undergoing LESS-CLSH between January 2014 and December 2016.
• Procedure involved two phases: LESS supracervical hysterectomy with conization, followed by transvaginal cervical conization and cylinderization.
• Uterine specimen extraction utilized contained manual morcellation with a tissue pouch.

Main Results:

• The difficult surgical group (uterus >12 cm, myoma, or adhesions) experienced longer operative times and greater blood loss compared to the nondifficult group.
• No significant differences were observed in visual analog scale (VAS) pain scores, pain relief, or hospitalization duration between groups.
• Minor complications were noted, with a significant reduction in cervical diameter and thickness observed at 3 months post-surgery.

Conclusions:

• LESS-CLSH is a safe, feasible, and minimally invasive surgical option for hysterectomy.
• The technique, particularly with contained manual morcellation, allows for controlled specimen removal.
• It is a viable approach even in cases of difficult laparoscopic hysterectomy.