| Objective: Compared with conventional laparoscopic surgery(CLS),Laparoendoscopic single-site surgery(LESS)can better hide the surgical incision and has cosmetic advantages,making it more popular among female gynecological patients.However,due to technical difficulties,the development of single-site laparoscopy has been slow in China,and its clinical effectiveness and safety have yet to be verified by more clinical data.In this study,we investigated the value of transumbilical single-port laparoscopy in benign gynecological disease surgery(including total hysterectomy,myomectomy,ovarian tumor debulking,and adnexal surgery)by comparing the clinical outcomes and safety analysis of transumbilical single-port laparoscopy with conventional laparoscopy in benign gynecological disease surgery.Methods:1 394 patients who underwent laparoscopic surgery by the same surgeon for benign gynecological diseases in the Affiliated Hospital of Jining Medical College from July 2021 to December 2022 were collected,and were divided into 195 cases in the single-port laparoscopic surgery group and 199 cases in the conventional laparoscopic surgery group according to the different surgical methods.31 cases in the LESS group had total hysterectomy,59 cases had myomectomy,33 cases had ovarian tumor debulking In the CLS group,there were 71 cases of total hysterectomy,25 cases of myomectomy,23 cases of ovarian tumor debridement and 80 cases of adnexal surgery.2 To compare the general data of patients in the two groups,the two groups were compared separately according to different surgical methods,including operating time,intraoperative bleeding,time of first postoperative venting,application rate of venting aid,time of first postoperative bowel movement,application rate of pain pump,application rate of pain medication,12 h postoperative pain score(abdomen and shoulder),24 h postoperative pain score(abdomen and shoulder),48 h postoperative pain scores,postoperative hospital days,total hospital costs,postoperative complications and patient satisfaction,and other indicators of clinical efficacy and economic value.Results:1 Comparison of patients’ general data: There was no statistically significant difference between the two groups in terms of general data such as age,Body Mass Index(BMI),number of pregnancies,number of deliveries and number of previous abdominal surgeries(P >0.05).In the two groups,there was no statistically significant difference in the size of the uterus removed,the diameter of the fibroids and the diameter of the ovarian tumor(P >0.05),and they were all comparable.2 In total hysterectomy: the operation was completed successfully.The LESS group had longer operation time and higher 24 h postoperative shoulder pain score(P <0.05);the differences between the two groups in terms of intraoperative bleeding,time to first postoperative evacuation,the application rate of evacuation aid,time to first postoperative bowel movement,the application rate of the pain pump,the application rate of pain medication,12 h postoperative pain score(abdomen,shoulder),pain score in the abdomen at 24 h postoperatively,pain score at 48 h post operatively,and the number of days in hospital postoperatively were not statistically significant(P>0.05).3 In myomectomy: both groups of patients completed the operation without abdominal opening.The LESS group had a longer operation time,a longer time for first postoperative defecation,and a higher pain score at48 h after surgery(P<0.05),and the results of intraoperative blood loss,first postoperative exhaust time,application rate of exhaust drugs,application rate of pain pump,application rate of pain relief drugs,pain score of 12 h postoperative(abdomen,shoulder),24 h postoperative pain score(abdomen and shoulder),and postoperative hospital stay were similar(P>0.05).4 In ovarian tumor peeling: the surgery was completed in both groups without transit laparotomy.The LESS group had less intraoperative bleeding,higher shoulder pain scores at 24 h postoperative,and shorter postoperative hospital stay(P<0.05),and there were no significant differences between the two groups in terms of operation time,first postoperative exhaust time,application rate of exhaust aiding drugs,first postoperative bowel movement time,application rate of pain pump,application rate of pain relief drugs,pain score(abdomen and shoulder)at12 h postoperatively,abdominal pain score at 24 h postoperative,and pain score at 48 h postoperative(P>0.05).In ovarian tumor debulking and adnexal surgery,the total hospital cost of LESS was similar to that of CLS,with transumbilical single-port laparoscopic surgery being more appropriate.5 In adnexal surgery: both groups of patients completed the operation without intermediate laparotomy.The LESS group had a longer first postoperative bowel movement time and a higher application rate of postoperative exhaust drugs(P<0.05),while there were no significant differences in operation time,intraoperative blood loss,postoperative first exhaust time,application rate of pain pump,application rate of pain relief drugs,pain score(abdomen and shoulder)at 12 h postoperatively,pain score(abdomen and shoulder)at 24 h postoperatively,pain score at 48 h postoperatively,number of postoperative hospital stays,and postoperative complications(P>0.05).6 Comparison of total hospital costs: In myomectomy and total hysterectomy,the total hospital cost in the LESS group was higher than that in the CLS group(P<0.05),and in ovarian tumor peeling and adnexal surgery,the total hospital cost of the two groups was similar,and the difference was not statistically significant(P>0.05).7 Comparison of patient satisfaction and complications: patient satisfaction was higher in the LESS group than in the CLS group(P<0.05).11 cases of postoperative complications were found in the LESS group,including 1 incisional hernia,3 umbilical discharge,3 incisional discomfort and 4 fever;10 cases of postoperative complications were found in the CLS group,including 2 incisional discomfort,6 fever and 2 cases of prolonged vaginal bleeding.The difference between the two groups was not statistically significant(P>0.05).Conclusion:1 Among benign gynecological diseases,the LESS group had higher patient satisfaction.LESS has a higher patient satisfaction rate in benign gynecological conditions.2 In total hysterectomy and myomectomy,the LESS group had a longer operation time,which often required higher surgical skills.3 In total hysterectomy and ovarian tumor peeling,shoulder pain in the LESS group had a higher score at 24 h after surgery.In myomectomy,the pain score was higher in the LESS group at 48 hours after surgery.In adnexal surgery,the LESS group had a longer postoperative first bowel movement and a higher rate of postoperative venting drugs.The LESS group did not have an advantage in the speed of postoperative gastrointestinal recovery.4 In ovarian tumor debulking and adnexal surgery,the LESS and CLS groups had similar surgical outcomes and total hospital costs,and combined with patient satisfaction,transumbilical single-port laparoscopic surgery was more suitable.5 The LESS group had similar surgical effects and postoperative complications as the CLS group,which proved that LESS was safe and feasible. |
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