Single-port Access Subtotal Laparoscopic Hysterectomy: A Prospective Case-Control Study

J Minim Invasive Gynecol. 2015 Jul-Aug;22(5):807-12. doi: 10.1016/j.jmig.2015.03.011. Epub 2015 Mar 18.


Study objective: The objective was to evaluate the perioperative outcomes, safety, and patient acceptance of single-port access laparoscopic subtotal hysterectomy (SPAL-SH) in comparison with conventional multiport access laparoscopic subtotal hysterectomy (MPAL-SH).

Design: Case-control study. Canadian Task Force Classification II-2.

Setting: The study was conducted at university hospitals in Cagliari, Italy, and Rouen, France.

Patients: Sixty-one women with metrorrhagia, abnormal uterine bleeding with uterine myomas, or symptomatic adenomyosis were included in the study.

Interventions: Thirty-one patients underwent SPAL-SH, and 30 patients underwent conventional MPAL-SH.

Measurements and main results: We analyzed the data to compare the outcomes of SPAL-SH versus MPAL-SH. Patients in the SPAL-SH group had longer operative times than those in the MPAL-SH group (p < .001) but shorter hospital stays (p < .001). Postoperative pain immediately after surgery, after 6 hours, and after 24 hours were lower in the SPAL-SH group (p < .001). The SPAL-SH group reported significantly higher cosmetic satisfaction at 1, 4, and 24 weeks after surgery (p < .01).

Conclusion: We conclude that SPAL-SH is a feasible and safe alternative to standard MPAL-SH in selected patients. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. In addition, SPAL-SH has a definite benefit in relation to body image and cosmesis.

Keywords: Laparoscopic subtotal hysterectomy; SPAL; Single-port access laparoscopy.

MeSH terms

  • Adenomyosis / surgery*
  • Case-Control Studies
  • Female
  • Humans
  • Hysterectomy* / methods
  • Laparoscopy*
  • Leiomyoma / surgery*
  • Length of Stay
  • Metrorrhagia / surgery*
  • Middle Aged
  • Operative Time
  • Pain, Postoperative / etiology
  • Patient Acceptance of Health Care
  • Prospective Studies
  • Treatment Outcome
  • Uterine Neoplasms / surgery*