Minimally invasive surgery is commonly used to treat gynecologic disease. Literature in the adult population supports that single incision laparoscopic surgery (SIL) is feasible and safe for the treatment of adnexal disease; however, there is little evidence for SIL in the pediatric population.A retrospective review of patients with gynecologic disease who underwent SIL from August 2009 to April 2012 was performed. All demographic data, clinical history, radiologic studies, indications for and type of operation, operative time and complications, and pathology were recorded.Thirty-four patients with a mean age of 12.5 years (range 3.6-17.4 years) underwent SIL for adnexal pathology. Operative interventions included cystectomy (56%), salpingo oopherectomy (26.5%), detorsion (8.8%), adnexal biopsy (5.9%), and oophoropexy (2.9%). Forty-four percent of the patients also underwent appendectomy. The mean operative time was 42.8 minutes. There was 1 wound infection (2.9%) and 2 patients (5.9%) required additional ports.Single incision laparoscopy provides a safe and effective approach to diagnostic laparoscopy with the ability to carry out operative interventions in multiple quadrants without adding additional ports. Single incision laparoscopy may be particularly effective in young women with abdominal pain requiring operative intervention.© 2013.

This study aimed to evaluate the safety and efficacy of laparoendoscopic single-site surgery (LESS) in treating adnexal disease during pregnancy.

<b><i>Background/Aims:</i></b> To assess the feasibility, safety and patient satisfaction of laparoendoscopic single-site (LESS) surgery for extremely large ovarian cysts. <b><i>Methods:</i></b> We conducted a prospective study of LESS surgery among women with ovarian cysts with a minimum diameter ≥15 cm and with radiological and laboratory features suggestive of benign disease. The primary outcomes were perioperative complication rate, conversion rate and patient satisfaction. <b><i>Results:</i></b> A total of 21 consecutive patients underwent the following LESS surgery over a period of 17 months: ovarian cystectomy (76%), adnexectomy (10%) and staging procedure (14%). Histological findings included benign (85%), borderline (10%) and malignant tumors (5%). Spillage occurred for 2 patients (10%). LESS surgery was successful without conversion in 20 patients (95%). There was 1 perioperative complication with subcutaneous hematoma (5%). The median operative time and estimated blood loss were 79.8 min (39-155) and 60 ml (10-180), respectively. Patients were highly satisfied with the results of LESS surgery, with a mean surgery satisfaction score of 9.4 ± 0.8 on a scale of 1-10. More than 71% of patients reported that the scar was invisible, and 95% said that they would recommend LESS surgery to others. <b><i>Conclusion:</i></b> Based on our results, with proper patient selection, the size of an ovarian cyst does not necessarily constitute a contraindication for LESS surgery.

Minimally invasive surgery is widely used in benign gynecologic diseases and may be used in malignancies. We performed a single-port access laparoscopy staging - bilateral salpingo-oophorectomy, laparoscopy-assisted vaginal hysterectomy, bilateral pelvic lymphadenectomy, infracolic omentectomy, and washing cytology - in a borderline ovarian tumor. The number of harvested pelvic lymph nodes were twenty-three and there were no intraoperative or postoperative complications. Single-port access laparoscopic staging may be performed in selected patients. The efficacy, safety, and potential benefits of this technique should be evaluated in further trials.

s The aims of this study were to assess the feasibility of single-port laparoscopic surgical staging (SPLS) in early ovarian cancer and to compare the surgical outcomes of SPLS with those of staging laparotomy.Between January 2014 and December 2018, 40 patients underwent SPLS and 41 patients underwent staging laparotomy at Yonsei Cancer Center. The patients were diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage I ovarian cancer. Variables such as patient age, body mass index (BMI), tumor size, FIGO stage, and perioperative surgical outcomes and survival outcomes of SPLS and laparotomy were compared.The total operation time was similar between the 2 groups (SPLS: 201.4 vs. laparotomy: 203.0 minutes, P=0.806). The median tumor diameters in the SPLS and laparotomy groups were 11.0 (2.5-28 cm) and 15.4 (6-40 cm), respectively (P=0.001). The SPLS group had lower tumor spillage rate (5.0% vs. 19.5%, P=0.047), less intraoperative blood loss (102.0 vs. 371.5 mL, P<0.001), less postoperative pain, and shorter postoperative hospital stay (5 vs. 9.5 days, P<0.001). The intraoperative major complication rate was similar between groups (2.5% vs. 4.9%, P=0.571). There was no significant difference in progression-free survival between the 2 groups (P=0.945). There were no deaths in either group.SPLS is feasible in early ovarian cancer and has better perioperative surgical outcomes, in some aspects, than staging laparotomy without compromising survival outcomes. SPLS could be performed in patients suspected to have early ovarian cancer.

Ovarian cancers are usually diagnosed at an advanced stage. The extent of the disease before surgery partly determines the ability to perform a complete cytoreduction. The peritoneal cancer index (PCI) is used to evaluate peritoneal carcinomatosis and has been validated in ovarian cancer and correlated with resectability. The aim of our study was to assess the feasibility of single-port laparoscopy (SPL) for suspicion of advanced ovarian cancer and to describe the ability to calculate the PCI score at the time of laparoscopy.Between February 2011 and January 2013, 33 patients underwent SPL for suspected advanced ovarian cancer. Individual records for all patients were prospectively reviewed and analyzed. For each patient, we determined the PCI score.33 patients underwent initial SPL, 85% had increased carcinological markers and 67% a radiological suspicion of peritoneal carcinomatosis. The median operative time was 90min. During SPL, 76% of patients underwent ascites evacuation; all patients had peritoneal cytology and peritoneal biopsies. Only 3 patients experienced perioperative complications. Two open conversions were recorded. Quotation of the PCI score was possible for all patients. Eighteen patients (55%) had a PCI score below 10; one had a maximal PCI score of 39. The PCI score was null for 9 patients. Non-browsing areas marked 8 procedures.SPL appeared to be feasible, with satisfying immediate results and postoperative outcome, compared to conventional laparoscopy. It allowed a satisfying exploration of the abdomino-pelvic cavity and a good description of peritoneal carcinomatosis with only a few non-browsing PCI areas.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Single-incision laparoscopic cholecystectomy (SILC) is a feasible technique that provides comparable results to standard laparoscopic cholecystectomy (LC). However, despite the theoretical advantages of minor wound complications and cosmetic results, SILC usually requires a larger incision, which may increase the incidence of incisional hernias. This study evaluated SILC and standard multiport cholecystectomy with respect to perioperative outcomes, hospital stay, cosmetic results, and postoperative complications, including the 5-year incisional hernia rate.A cohort study was performed with patients who underwent elective laparoscopic surgery for noncomplicated cholelithiasis at our hospital between July 2009 and June 2011. During the study period, there were 45 nonselected patients who underwent SILC, and these patients were compared with a control group of 140 patients who underwent LC using the standard three-trocar technique during the same period. Both patient groups were comparable in age, gender, BMI and ASA classification.The mean follow-up was 58.7 ± 10.9 (range 3-80) months. There were no differences between groups in terms of hospital stay, rate and severity of complications, wound infection, and patient cosmetic satisfaction. However, the operating time (57.8 versus 35.2 min) and long-term incisional hernia rate (13.3% versus 4.7%) were significantly higher in the SILC group.SILC is associated with a statistically significantly higher long-term incisional hernia rate at the umbilical port site than the standard multiport laparoscopic cholecystectomy. Our data show there was no relevant advantage regarding the postoperative course, hospital stay or cosmetic satisfaction. To date, widespread use of SILC cannot be recommended. Registration number: NCT03768661 (https://www.clinicaltrials.gov).This study has been registered at www.clinicaltrials.gov. The clinicaltrials.gov ID number is: NCT03768661.

Ovarian cysts are very common diseases of the female reproductive system. Giant ovarian cysts refer to the tumors with diameters greater than 10 cm. In recent years, due to the development of clinical diagnosis, imaging modalities, and the improvement of patients’ cognition of the diseases, the occurrence of giant ovarian cysts has become rare. The purpose of this study was to show a new operation method of single-port laparoscopy to treat giant ovarian cysts.