Department of Gynecology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
Shantou University Medical College, Shantou, Guangdong, China.
BMJ Open. 2020 Feb 16;10(2):e032331. doi: 10.1136/bmjopen-2019-032331.
We aimed to evaluate the safety, efficiency and preferred indication for laparoendoscopic single-site surgery (LESS) compared with conventional laparoscopic (CL) surgery for benign ovarian masses.
A systemic review and cumulative meta-analysis were performed in line with the criteria of Grading of Recommendations Assessment, Development and Evaluation: levels of evidence and grades of recommendation.
We comprehensively searched the electronic databases including PubMed, Medline, Embase and the Cochrane Library in November 2018.
We included all randomised controlled trials (RCTs) and retrospective studies published in recent 10 years, which investigated the performance of LESS versus CL in patients at all ages with benign ovarian masses.
Four RCTs and nine retrospective studies published in recent decade including 1542 cases (744 cases for LESS and 798 cases for CL) were identified. Perioperative complication was consisted of intraoperative and postoperative complications, including ileus, wound infection or dehiscence and incisional hernia. Although LESS has less postoperative analgesic consumption (46.78% and 79.25%; OR: 0.49; 95% CI: 0.33 to 0.74, p<0.001) and shorter hospital stay (weighted mean difference (WMD): -0.24 days; 95% CI: -0.35 to -0.14; p<0.001), CL has less perioperative complications (6.59% and 2.85%; OR: 2.08; 95% CI: 1.05 to 4.11, p=0.04) and shorter operative time (WMD: 3.43 min; 95% CI: -0.03 to 6.88; p=0.05). Body mass index, history of previous abdominal surgery, size of adnexal mass, estimated blood loss and postoperative pain scores did not differ significantly between two techniques.
The indications of LESS for benign ovarian masses are similar to CL and it has better postoperative recovery. However, with less perioperative complications, CL surgery is safer than LESS.
我们旨在评估与传统腹腔镜（CL）手术相比，单孔腹腔镜手术（LESS）治疗良性卵巢肿块的安全性、效率和首选适应证。
根据推荐评估、制定和评估分级标准的标准，进行系统评价和累积荟萃分析：证据水平和推荐等级。
我们于 2018 年 11 月全面检索了电子数据库，包括 PubMed、Medline、Embase 和 Cochrane 图书馆。
我们纳入了所有最近 10 年发表的随机对照试验（RCT）和回顾性研究，这些研究调查了 LESS 与 CL 在所有年龄段患有良性卵巢肿块的患者中的表现。
确定了 4 项 RCT 和 9 项最近 10 年发表的回顾性研究，共纳入 1542 例患者（LESS 组 744 例，CL 组 798 例）。围手术期并发症包括术中及术后并发症，包括肠梗阻、伤口感染或裂开和切口疝。虽然 LESS 术后镇痛药物消耗较少（46.78%和 79.25%；OR：0.49；95%CI：0.33 至 0.74，p<0.001），住院时间较短（加权均数差（WMD）：-0.24 天；95%CI：-0.35 至-0.14；p<0.001），但 CL 组围手术期并发症较少（6.59%和 2.85%；OR：2.08；95%CI：1.05 至 4.11，p=0.04），手术时间较短（WMD：3.43 分钟；95%CI：-0.03 至 6.88；p=0.05）。两种技术之间的体重指数、既往腹部手术史、附件肿块大小、估计失血量和术后疼痛评分无显著差异。
LESS 治疗良性卵巢肿块的适应证与 CL 相似，且术后恢复更好。然而，CL 手术的围手术期并发症较少，因此比 LESS 更安全。
