Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Minim Invasive Gynecol. 2013 Mar-Apr;20(2):160-5. doi: 10.1016/j.jmig.2012.09.013. Epub 2013 Jan 11.
The aim of this study was to compare operative outcomes from 300 patients who underwent laparoendoscopic single-site surgery (LESS) with hysterectomy (H) according to previous cesarean section and to describe the bladder dissection technique in detail.
Retrospective cohort study (Canadian task classification II-2).
A university hospital, research hospital, and a tertiary care center.
In total, 300 LESS-H procedures were performed for benign gynecologic disease, cervical disease, and endometrial disease at Samsung Medical Center in Seoul, Korea, between May 2008 and February 2012. Patients were categorized into 2 groups according to previous cesarean history: the previous cesarean section group (n = 98) and the no history of previous cesarean section group (n = 202).
LESS-H with vaginal or lateral approach for bladder dissection.
Baseline demographics and clinical characteristics, except for age, were generally the same between the 2 groups. The operative outcomes including operative time, uterine weight, estimated blood loss, hemoglobin change, hospital stay, and transfusion rate were not different between the 2 groups. Adhesiolysis was required more in the previous cesarean section group (p = .002). LESS failure requiring additional trocars occurred more often in the previous cesarean section group (p = .041), but the rates of conversion to laparotomy were not different (p = .327). The overall surgical complication rate except transfusion was 2.67% in this study. Two cases of urologic problems with ureter injury or bladder injury were reported in the previous cesarean section group. In the no previous cesarean section group, there were 2 urologic problems.
LESS-H is a feasible procedure with a lateral approach or vaginal approach for bladder dissection, even in patients with previous cesarean section.
本研究旨在比较 300 例接受经腹腔镜单部位手术（LESS）和子宫切除术（H）的患者的手术结果，这些患者根据既往剖宫产史进行分组，并详细描述膀胱分离技术。
回顾性队列研究（加拿大任务分类 II-2）。
一家大学医院、研究医院和一家三级保健中心。
2008 年 5 月至 2012 年 2 月，韩国首尔三星医疗中心共对 300 例因良性妇科疾病、宫颈疾病和子宫内膜疾病行 LESS-H 的患者进行了手术，这些患者根据既往剖宫产史分为两组：既往剖宫产组（n=98）和无既往剖宫产史组（n=202）。
LESS-H 经阴道或侧方入路进行膀胱分离。
两组患者的基线人口统计学和临床特征除年龄外基本相同。两组患者的手术结果（包括手术时间、子宫重量、估计出血量、血红蛋白变化、住院时间和输血率）无差异。既往剖宫产组粘连松解术的需求更多（p=0.002）。既往剖宫产组发生需要额外Trocar 的 LESS 失败的比例更高（p=0.041），但中转开腹的比例无差异（p=0.327）。本研究中转运除外的总体手术并发症率为 2.67%。有 2 例发生在既往剖宫产组的泌尿系统问题，分别为输尿管损伤或膀胱损伤。在无既往剖宫产史组，有 2 例发生泌尿系统问题。
即使在既往剖宫产的患者中，经腹腔镜单部位手术（LESS）联合经阴道或侧方入路进行膀胱分离也是一种可行的方法。
