Laparoendoscopic single-site (LESS) surgery in patients with benign adnexal disease

Objective: To present our initial experience in laparoscopic surgery for benign adnexal disease performed exclusively through an umbilical incision using a single three-channel port and flexible laparoscopic instrumentation. Design: Case report. Setting: Tertiary-care referral center. Patient(s): Since November, 2008, we have performed single-port laparoscopic surgery in nine patients diagnosed with benign adnexal disease. Patients with adnexal masses or endometriosis and a body mass index of <35 kg/m² were selected. Intervention(s): Laparoendoscopic single-site (LESS) surgery. In each case, a multichannel port was inserted into the peritoneum through a 1.5-2.0-centimeter umbilical incision. Main Outcome Measures: Feasibility, postoperative pain score, age, BMI, estimated blood loss. Result(s): Eight of nine cases were completed successfully, without conversion to a standard laparoscopic approach or to laparotomy. An additional 3 mm extraumbilical port was required in one patient with stage 4 endometriosis. Seven out of nine patients had earlier abdominal surgery. The operative blood loss ranged from minimal to 75 mL. Duration of hospital stay was <24 hours in all cases. Minimal use of postoperative narcotics was required, and no intraoperative complications occurred. Conclusion(s): The LESS surgery for benign adnexal disease is feasible in patients with or without earlier surgery. Additional investigation is needed to evaluate the safety and long-term outcomes of this new approach.