Concealing scars in a simple way: transumbilical single-site dual-incision laparoscopic surgery for benign adnexal...

While laparoendoscopic single-site surgery (LESS) theoretically improves cosmesis through a single umbilical incision, evidence on patient-reported cosmetic satisfaction remains equivocal. Technical challenges in umbilical incision closure and reliance on costly disposable devices further limit its adoption in resource-constrained settings. The transumbilical single-site dual-incision (SSDI) approach circumvents these challenges through strategic dual umbilical incision placement. This design enables surgeons to apply conventional instruments and umbilical incision suturing techniques which are comparable to multiport laparoscopy. This study aimed to compare surgical outcomes and cosmetic satisfaction between transumbilical SSDI laparoscopic surgery using conventional instruments and standard LESS for benign adnexal diseases.

A total of 116 patients with benign adnexal diseases underwent transumbilical SSDI laparoscopic surgery using conventional laparoscopic instruments (n = 52) or standard LESS (n = 64) were retrospectively analyzed.

Both procedures were successfully performed in all patients. SSDI technique preserved the integrity of the base of umbilical fossa in 88.5% (46/52) of cases, obviating the need for complex umbilical reconstruction. Compared to the LESS group, the SSDI group demonstrated significantly shorter total operation time (44.6 ± 18.9 vs. 56.8 ± 14.9 min, P < 0.001) and incision suturing time (3.6 ± 4.4 vs. 15.4 ± 2.5 min, P < 0.001). Additionally, hospital costs were significantly lower in the SSDI group (9,137.4 ± 891.3 vs. 11,920.2 ± 924.5 RMB, P < 0.001). No significant differences were observed between the two groups in terms of estimated blood loss, delayed discharge, wound infection, trocar-site hernia, or cosmetic satisfaction. At the 3-month postoperative follow-up, the majority of patients in both groups reported great satisfaction with cosmetic outcomes.

Transumbilical SSDI laparoscopic surgery using conventional instruments represents a technically feasible and economically advantageous alternative to standard LESS for benign adnexal diseases. This "back-to-basics" approach may enhance the accessibility of single-site laparoscopy, particularly in resource-limited settings.