Single-port-access laparoscopic-assisted vaginal hysterectomy versus conventional laparoscopic-assisted vaginal hysterectomy: a comparison of perioperative outcomes.

BACKGROUND

The objective of the study was to compare the perioperative outcomes, including the operative time, length of hospital stay, and postoperative pain, of a single-port-access laparoscopic-assisted vaginal hysterectomy (SPA-LAVH) and conventional LAVH.

METHODS

This is a retrospective case-control study. A single surgeon performed 43 SPA-LAVH (cases) between May 2008 and February 2009, and 43 conventional LAVH between September 2005 and April 2008 (controls). Data of the SPA-LAVH cases were collected prospectively into our data registry and we reviewed the data of controls on chart.

RESULTS

The demographic parameters, except a history of vaginal delivery, were comparable between the two groups. The SPA group was associated with a history of fewer vaginal deliveries (SPA, 63%; conventional, 84%; p = 0.03). The two groups were comparable with respect to indications for surgery, failed cases from planned procedures, cases requiring additional procedures, and cases needing transfusion. The operative time, estimated blood loss (EBL), drop in hemoglobin preoperatively to postoperative day 1, and postoperative hospital stay were comparable between both groups. SPA-LAVH was associated with reduced postoperative pain. The VAS-based pain scores 24 h (SPA, 2.5 ± 0.7; conventional, 3.5 ± 0.8; p < 0.01) and 36 h after surgery (SPA, 1.7 ± 1.2; conventional, 2.9 ± 1.1; p < 0.01) were lower in the SPA group. There were no complications, including reoperation, adjacent organ damage, and any postoperative morbidity, in both groups. In addition, we have encountered no umbilical complications to date using SPA.

CONCLUSIONS

Our study demonstrated that SPA-LAVH has comparable operative outcomes to conventional LAVH and the postoperative pain was decreased significantly in the SPA group 24 and 36 h after surgery.