Review and meta-analysis of prospective randomized controlled trials (RCTs) comparing laparo-endoscopic single site and multiport laparoscopy in gynecologic operative procedures

Arch Gynecol Obstet. 2016 Sep;294(3):567-77. doi: 10.1007/s00404-016-4108-8. Epub 2016 May 11.


Purpose: To critically appraise published randomized controlled trials (RCTs) comparing laparo-endoscopic single site (LESS) and multi-port laparoscopic (MPL) in gynecologic operative surgery; the aim was to assess feasibility, safety, and potential benefits of LESS in comparison to MPL.

Methods: A systematic review and meta-analysis of eleven RCTs. Women undergoing operative LESS and MPL gynecologic procedure (hysterectomy, cystectomy, salpingectomy, salpingo-oophorectomy, myomectomy). Outcomes evaluated were as follows: postoperative overall morbidity, postoperative pain evaluation at 6, 12, 24 and 48 h, cosmetic patient satisfaction, conversion rate, body mass index (BMI), operative time, blood loss, hemoglobin drop, postoperative hospital stay.

Results: Eleven RCTs comprising 956 women with gynecologic surgical disease randomized to either LESS (477) or MPL procedures (479) were analyzed systematically. The LESS approach is a surgical procedure with longer operative and better cosmetic results time than MPL but without statistical significance. Operative outcomes, postoperative recovery, postoperative morbidity and patient satisfaction are similar in LESS and MPL.

Conclusion: LESS may be considered an alternative to MPL with comparable feasibility and safety in gynecologic operative procedures. However, it does not offer the expected advantages in terms of postoperative pain and cosmetic satisfaction.

Keywords: Laparo-endoscopic single site; Laparoscopic approach; Multiport laparoscopy; Single port gynecology; Single port hysterectomy.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Female
  • Gynecologic Surgical Procedures / methods*
  • Humans
  • Hysterectomy / methods
  • Laparoscopy / methods*
  • Pain, Postoperative / epidemiology
  • Patient Satisfaction
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Salpingectomy
  • Uterine Myomectomy / methods