Zhao Mingzhi, Zhao Jing, Hua Keqin, Zhu Zhiling, Hu Changdong
Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University Shanghai 200090, China.
Int J Clin Exp Med. 2015 Sep 15;8(9):14992-8. eCollection 2015.
To estimate the feasibility and safety of single-incision multiport laparoscopy (SIMPL) used in patients who underwent laparoendoscopic single-site surgery (LESS) for gynecologic disease, and the cosmetic outcome and economic benefit compared with multichannel-tipped single port laparoscopy (MSPL).
We underwent LESS via a single 2.5- to 3.0-cm umbilical incision with the Single-Incision Multiport Laparoscopic Surgery Trocar available on the market, briefly named MSPL. Since January 2014, we improved the procedure and named SIMPL. In SIMPL group, two traditional laparoscopic trocar (diameter=5 mm) and one mini-laparoscopic trocar (diameter =3 mm) were inserted into the peritoneum separately through a single 1.5- to 1.8-cm umbilical transcutaneous incision. Subject demographics and clinical variables were collected and perioperative outcomes analyzed. In addition, the size of umbilicus was measured in all patients prior to the operation and the levels of cosmetic satisfaction were evaluated at 4 weeks after surgery.
From January 2014 to December 2014, there were 32 patients who underwent SIMPL for ovarian cystectomy. Hospital cost was significantly lower in SIMPL group compared with MSPL group (RMB 10207.0 vs 17973.7 yuan), P<0.001. Compared with MSPL group, the SIMPL group reported significantly higher cosmetic satisfaction at 4 weeks afer surgery (P<0.1). Besides, the SIMPL procedures performed in benign gynecologic surgery were myomectomy (n=8), salpingpoophorectomy (n=2), salpingectomy (n=5), adhesiolysis and fimbrioplasty (n=32), ovarian drilling (n=3), salpingotomy for ectopic pregnancy (n=3). All surgeries were completed successfully without conversion to the traditional laparoscopic approach. Two postoperative complications occurred were delay healing of umbilicus incision after myomectomy. The cosmetic satisfactory rate was 100%.
According to our experience, SIMPL is safe and efficient for simple gynecologic operation, with lower cost and better cosmetic results than MSPL. Beyond cosmetic and economic results, further randomized studies are needed to identify a possible benefit.
评估单切口多通道腹腔镜手术（SIMPL）应用于因妇科疾病接受腹腔镜下单孔手术（LESS）患者的可行性与安全性，以及与多通道单孔腹腔镜手术（MSPL）相比的美容效果和经济效益。
我们使用市场上现有的单切口多通道腹腔镜手术套管针，通过一个2.5至3.0厘米的脐部切口进行LESS手术，简称为MSPL。自2014年1月起，我们改进了该手术并将其命名为SIMPL。在SIMPL组中，两个传统腹腔镜套管针（直径 = 5毫米）和一个迷你腹腔镜套管针（直径 = 3毫米）通过一个1.5至1.8厘米的脐部经皮切口分别插入腹腔。收集患者人口统计学和临床变量，并分析围手术期结果。此外，在所有患者手术前测量脐部大小，并在术后4周评估美容满意度水平。
2014年1月至2014年12月，有32例患者接受了SIMPL卵巢囊肿切除术。SIMPL组的住院费用显著低于MSPL组（10207.0元对17973.7元），P<0.001。与MSPL组相比，SIMPL组在术后4周的美容满意度显著更高（P<0.1）。此外，SIMPL在良性妇科手术中进行的手术包括子宫肌瘤切除术（n = 8）、输卵管卵巢切除术（n = 2）、输卵管切除术（n = 5）、粘连松解和伞端成形术（n = 32）、卵巢打孔术（n = 3）、异位妊娠输卵管切开术（n = 3）。所有手术均成功完成，未转为传统腹腔镜手术方式。发生了2例术后并发症，即子宫肌瘤切除术后脐部切口延迟愈合。美容满意率为100%。
根据我们的经验，SIMPL对于简单的妇科手术是安全有效的，与MSPL相比成本更低且美容效果更好。除了美容和经济结果外，还需要进一步的随机研究来确定可能的益处。
