Mun‑Kun Honga,b,c, Tang‑Yuan Chua,b,c, Jen‑Huang Wangd, Dah‑Ching Dinga,b,c*
aDepartment of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, bInstitute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, cMinimally Invasive Gynecology Surgery
Center, Buddhist Tzu Chi Hospital, Hualien, Taiwan, dDepartment of Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation
Abstract
Objective: To report our initial experience with and the short‑term outcomes of two‑phase laparoendoscopic single‑site cervical ligament‑sparing hysterectomy (LESS‑CLSH). Materials and Methods: A retrospective case study included 40 women who underwent LESS‑CLSH from January 2014 to December 2016 at Buddhist Tzu Chi General Hospital. Uterine specimens were extracted through contained manual morcellation with a tissue pouch. The first phase was LESS supracervical hysterectomy and conization of the internal orifice of the cervix. The second phase was transvaginal cervical conization and
cylinderization. Women with a uterus diameter of >12 cm, a broad ligament myoma, or severe pelvic adhesion were categorized into a difficult group, and others were categorized into a nondifficult group. Results: The difficult group required more time and had more blood loss than the nondifficult group. The mean surgical time was 187.2 ± 33.9 and 139.1 ± 20.7 min, and the mean blood loss was 533.3 ± 333.3 and 225.3 ± 168.2 mL in the difficult and nondifficult groups, respectively. The overall visual analog scale (VAS) pain scores at 0–4, 24, and 48 h after surgery were 7.1 ± 1.9, 4.2 ± 1.6, and 2.3 ± 1.5,
respectively; no difference in the VAS pain scores, pain relief score, and hospitalization duration was observed between the two groups. Minor surgical complications or adverse events on follow‑up were noted. Three months after surgery, the diameter and thickness of the cervix were decreased by approximately 0.5 and 1.0 cm, respectively. Conclusion: LESS‑CLSH is a minimally invasive, safe, and feasible approach, even for difficult laparoscopic hysterectomy. Contained manual morcellation enables more controlled specimen removal than morcellation only.
Keywords: Cervical ligament sparing, Hysterectomy, Laparoendoscopic single site, Single port
