Elsevier

Journal of Minimally Invasive Gynecology

Volume 16, Issue 5, September–October 2009, Pages 612-615
Journal of Minimally Invasive Gynecology

Instruments and Techniques
Single Port Access Laparoscopic Adnexal Surgery

https://doi.org/10.1016/j.jmig.2009.06.011Get rights and content

Abstract

Study Objective

To estimate the feasibility, safety, and operative outcomes for the management of adnexal masses by single port access (SPA) laparoscopy with a wound retractor and a surgical glove.

Design

A prospective single-center study (Canadian Task Force classification III).

Setting

University hospital.

Patients

Twenty-four well selected patients with adnexal masses on imaging scans recruited from June 2008 through January 2009.

Interventions

Single port access laparoscopic adnexal surgery.

Measurements and Main Results

Single port access laparoscopic adnexal surgery was successfully completed in 22 of 24 patients. The median age of the patients was 45 years (range 23-63 years), and the median body mass index was 22 (range 18-29). The median tumor size was 5 cm (range 3-12 cm). The median operative time was 70 minutes (range 40-128 minutes). The estimated blood loss was minimal (range 10-100 mL). The postoperative course was uneventful in all patients. The median postoperative hospital stay was 1 day (range 1-3 days). No postoperative complications were observed at follow-up. The 2 failed cases were as follow: 1 required an additional trocar for adequate adhesiolysis, and the other a staging laparotomy because of the finding of a borderline ovarian malignancy on frozen section pathologic study.

Conclusion

The single port access laparoscopic adnexal surgery was safe and feasible and provided almost no visual scar.

Section snippets

Patients

Beginning June 25, 2008, SPA laparoscopic adnexal surgery was performed by a single gynecology surgeon (T.J. Kim) in 24 patients. Inclusion criteria were as follows: age < 70 years, an adnexal mass on ultrasonography or pelvic magnetic resonance image, and patients who consented to SPA procedures. Patients were excluded for adnexal tumors suspicious for malignancy, severe obesity (body mass index > 30 kg/m2), or patients who were at high risk for general anesthesia. Patient workup (history taking

Results

SPA laparoscopic adnexal surgery was successfully completed in 22 of 24 patients. The 2 failed cases were as follows: 1 required an additional trocar in the right lower quadrant of the abdomen for adequate adhesiolysis, and the other a staging laparotomy immediately after successfully finishing SPA laparoscopic oophorectomy because of the finding of a borderline ovarian malignancy on frozen section pathologic study.

Table 1 shows the patient characteristics and operative outcomes. The median age

Discussion

SPA laparoscopy was introduced to the field of gynecology for tubal sterilization about 4 decades ago [5]. However, SPA laparoscopic adnexal surgery did not gain widespread use because of the technical challenges associated with complex maneuvers intracorporeally for which there were no instruments available. Currently, with the availability of specialized instruments and multichannel ports, SPA laparoscopy has become a rapidly evolving field 8, 9, 10. Because the uterine manipulator through

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The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.

1

Both of these authors contributed equally to this work.

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