Departments of Obstetrics and Gynecology and Surgery, McMaster University, Hamilton, Ontario, Canada; and the Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Obstet Gynecol. 2013 Apr;121(4):819-828. doi: 10.1097/AOG.0b013e318288828c.
To evaluate surgical outcomes for gynecologic surgery performed by single-incision laparoscopy compared with conventional multi-incision laparoscopy.
We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and clinicaltrials.gov through August 2012. We also screened reference lists of retrieved articles and manually searched abstracts from conference proceedings.
We included randomized control trials (RCTs) and high-quality observational studies that compared outcomes for single-incision laparoscopy and conventional laparoscopy for gynecologic surgery in patients. Included studies met predefined quality criteria and reported, at minimum, on complications, conversions, and operative time. TABULATION, INTEGRATION, RESULTS: Six RCTs and 15 observational studies met inclusion criteria, with a total of 2,085 patients (899 single-incision laparoscopies and 1,186 conventional laparoscopies). In the pooled analysis, there was no significant difference in the risk of total complications between single-incision laparoscopy and conventional laparoscopy groups (relative risk 1.01, 95% confidence interval [CI] 0.72-1.40; P=.97, random effects model). The meta-analysis was powered to detect a 5% difference in complications (power=0.8, alpha=0.05). Mean operative time for adnexal surgery performed by single-incision laparoscopy was 6.97 minutes longer than conventional laparoscopy (95% CI 0.16-13.77; P=.045; I=47.2; random effects based on three RCTs). There was no significant difference in mean operative time for hysterectomy procedures performed by single-incision laparoscopy (8.29 minutes, 95% CI -5.85 to 22.43; P=.251; I=83.6; random effects based on three RCTs). Clinical outcomes of postoperative pain, change in hemoglobin, length of hospital stay, and scar cosmesis could not be pooled because of paucity of data and lack of uniform reporting.
There was no difference in the risk of complications between single-incision laparoscopy and conventional laparoscopy approaches in gynecologic surgery. Studies with imprecise effect sizes suggest that single-incision laparoscopy may have longer operative time for adnexal surgery, but not for hysterectomy. Effects on other surgical outcomes remain uncertain.
评估经单切口腹腔镜与传统多孔腹腔镜行妇科手术的手术结果。
我们检索了 MEDLINE、Embase、Cochrane 对照试验中心注册库和临床试验.gov，检索截至 2012 年 8 月。我们还筛选了检索到的文章的参考文献列表，并人工检索了会议论文集的摘要。
我们纳入了比较单切口腹腔镜与传统腹腔镜行妇科手术的随机对照试验（RCT）和高质量观察性研究。纳入的研究符合预先确定的质量标准，至少报告了并发症、中转、手术时间。
列表、整合、结果：6 项 RCT 和 15 项观察性研究符合纳入标准，共有 2085 名患者（899 例单切口腹腔镜手术，1186 例传统腹腔镜手术）。在汇总分析中，单切口腹腔镜组与传统腹腔镜组的总并发症风险无显著差异（相对风险 1.01，95%置信区间[CI]0.72-1.40；P=0.97，随机效应模型）。该meta 分析的效能可检测出 5%的并发症差异（效能=0.8，alpha=0.05）。经单切口腹腔镜行附件手术的平均手术时间比传统腹腔镜长 6.97 分钟（95%CI0.16-13.77；P=0.045；I=47.2；基于 3 项 RCT 的随机效应模型）。经单切口腹腔镜行子宫切除术的平均手术时间无显著差异（8.29 分钟，95%CI-5.85 至 22.43；P=0.251；I=83.6；基于 3 项 RCT 的随机效应模型）。由于数据匮乏和缺乏统一报告，术后疼痛、血红蛋白变化、住院时间和疤痕美容等临床结局无法进行汇总分析。
妇科手术中单切口腹腔镜与传统腹腔镜方法的并发症风险无差异。效应量不精确的研究表明，单切口腹腔镜行附件手术的手术时间可能较长，但行子宫切除术时则不然。其他手术结局的影响尚不确定。
