Comparative Analysis Of Sing-site And Traditional Laparoscopy For The Treatment Of Gynecological Cancers

Objective: To explore the clinical efficacy and safety of transumbilical laparoendoscopic single-site surgery(TU-LESS)and conventional laparoscopic surgery(CLS)in the treatment of the three most common gynecological malignant tumors(endometrial cancer,cervical cancer and ovarian cancer)under the use of conventional laparoscopic instruments,followed by comparative analysis,and to study the application value and shortcomings in clinical practice.Methods:1.Patients(n = 91)undergoing surgical treatments by the same doctor for the three most common gynecological malignant tumors(endometrial cancer,cervical cancer and ovarian cancer)in the Department of Gynaecology of the Affiliated Hospital of Jining Medical University from January 2017 to January 2019 were selected.The clinical outcomes of the 91 patients were retrospectively analyzed,and patients were divided into TU-LESS group(n = 34)and CLS group(n = 57)according to different surgical treatments.2.Clinical efficacy and safety indexes were compared between the TU-LESS group and the CLS group,including baseline information,intraoperative blood loss,operation time,intraoperative injuries,pelvic lymph node dissection number,postoperative anal exhaust recovery time,postoperative antibiotic application days,postoperative drainage tube indwelling days,postoperative urinary catheter indwelling time,postoperative hospitalization days and postoperative complications.3.Statistical analysis was carried out by using GraphPad prism 8.0statistical software.The quantitative data were expressed as mean ±standard deviation(x ± s),and t-tests are used to compare pairwise differences between groups.For continuous variables,The chi-squaretest was used for the comparisons between groups,with significance level? = 0.05.When P < 0.05,there was a statistical significance.Results:1.Comparisons in baseline informationAmong the 91 patients with gynecological malignancies,34 cases underwent TU-LESS,and 57 cases underwent CLS.There was no significant difference in terms of age,BMI,height,abdominal operation history and childbearing history before operation between the TU-LESS group and the CLS group(P > 0.05).2.Comparisons in intraoperative observation indexes between the two groupsThe operation in the TU-LESS group and the CLS group were successfully completed without conversion to laparotomy.Vascular and organ injuries were observed in the TU-LESS group(n = 4)and the CLS group(n = 1),with a statistical difference in intraoperative injuries between the two groups(P < 0.05).The pelvic lymph node dissection was performed in the two groups,and there was no statistical difference in the pelvic lymph node dissection number between the two groups(P > 0.05);compared with the CLS group,the average operation time of the TU-LESS group was longer,with a statistical difference in the operation time(P < 0.05);but there was no statistical difference in the intraoperative blood loss between the two groups(P > 0.05).3.Comparisons in postoperative observation indexes between the two groupsThe postoperative complications were found in the two groups(5cases per group),the rates of using painkillers were 47.1% in the single hole group and 22.8% in the conventional group,with a statistical significance(P < 0.05);there was a significant difference in the postoperative anal exhaust recovery time between the two groups(2.0 ±0.5 days vs.1.8 ± 0.6 days,P < 0.05);but there was no significant difference in the postoperative antibiotic application days,postoperative pelvic drainage tube indwelling days,postoperative urinary catheter indwelling time and postoperative hospitalization days between the two groups(P > 0.05).Conclusion:The TU-LESS was successfully completed for the three most common gynecological malignant tumors using the conventional laparoscopic instruments,with similar short-term operation effects of the CLS,thus providing an alternative operation mode for women with the pursuit of "scar-free".Under the condition of using the same conventional laparoscopic instruments,the operation time of the TU-LESS group were higher than that of the CLS group,which indicates that the single-hole laparoscopy technique increases the difficulty of surgery and requires the surgeon to practice more on the basis of mature traditional laparoscopy.Under the same use of traditional laparoscopic instruments,the use rate of analgesics and postoperative exhaust gas recovery time of the single-hole laparoscopy group are higher than those of the traditional laparoscopy group.In this regard,single-hole laparoscopy has no advantages.Carefully choose the surgical method under full communication with patients who are pursuing "scar-free".