Single-incision laparoscopy as the primary approach to benign hysterectomies: A single-surgeon, single-year-experience with a retrospective control

Background: Most studies describing experience with laparoendoscopic single-site surgery hysterectomy are multi-institutional. These studies report the pooled experience of multiple providers. Consequently, these studies do not reflect the single-provider experience, a perspective that is most relevant to the individual practitioner. Objective: The aim of this study was to analyze the experience of a single provider with single-incision laparoscopy as a primary approach to all benign hysterectomies. Materials and Methods: This retrospective cohort study was conducted in a northeastern U.S. hospital involving patients who underwent hysterectomies for benign indications. The patients were operated on by a single surgeon over a 1-year period before and after initiation of a single-incision program at the hospital. Group differences were compared using the Student's t-test.The main outcome measure sought was operative time. Results: Overall 37 patients underwent hysterectomy via a single-incision approach, while 41 had conventional multiport laparoscopy. There were no statistically significant differences in body mass index, age, or number of previous surgeries between the groups. The weight of the uterine specimens was significantly higher in the single-incision group (249±192), compared to the conventional laparoscopy group (106±46). The mean time of procedure and EBL did not differ between the two groups. There was one conversion to laparotomy in the conventional laparoscopy group, as a result of extensive adhesions and technical difficulties, and one major intraoperative complication in the single-incision group (bladder and bowel injury) requiring minilaparotomy. Fourteen (39%) patients in the single-incision laparoscopy group required placement of at least one additional trocar through a separate incision. Conclusions: Transition to single-incision laparoscopy as the primary approach to hysterectomy for benign indications is possible. Operative time and morbidity are not significantly altered.