Department of Obstetrics and Gynecology, Huai'an Maternity and Child Healthcare Hospital Affiliated to Yangzhou Medical University, Jiangshu, China.
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
JSLS. 2021 Apr-Jun;25(2). doi: 10.4293/JSLS.2021.00019.
Minimally invasive surgery is currently a preferred treatment for symptomatic ovarian cyst(s), with single-site techniques, such as transumbilical laparoendoscopic single-site surgery (TU-LESS) and transvaginal laparoendoscopic single-site surgery (TV-LESS), gaining increasing popularity. Although both methods have delivered positive outcomes, there is currently limited literature directly comparing TU-LESS and TV-LESS.
This study had two primary objectives: (1) to evaluate the safety and feasibility of TV-LESS and TU-LESS for the treatment of ovarian cysts and (2) to compare the surgical and postoperative outcomes of the two procedures.
This was a prospective observational clinical analysis of 81 patients with a diagnosis of benign ovarian cyst with indication for TV-LESS or TU-LESS. Surgeries were performed at a tertiary hospital between February 1, 2018 and January 31, 2020. Patients were divided into TV-LESS (n = 40) and TU-LESS groups (n = 40), with one excluded due to severe pelvic adhesive disease. Demographics, operation outcomes, and follow-up details were compared.
All 80 patients underwent uncomplicated procedures. The two groups were demographically matched (except age), with no difference in operation time, intra-operative blood loss, hemoglobin loss, and hospitalization costs (P > 0.05). However, TV-LESS patients had significantly faster time to ambulation (P < 0.001), faster time to return of bowel function (P < 0.001), less postoperative pain level (P < 0.001), and shorter length of hospital stay (P < 0.001). The cosmetic scores at 1, 4, and 24 weeks after surgery were also higher for the TV-LESS group.
Our preliminary experience suggested that TU-LESS and TV-LESS are both feasible and safe for ovarian cystectomy and salpingo-oophorectomy. However, TV-LESS may provide three main advantages including: (1) fewer postoperative complications (i.e. incisional hernia); (2) less postoperative pain; and (3) improved cosmetic satisfaction.
微创手术目前是治疗有症状卵巢囊肿的首选方法，单部位技术，如经脐腹腔镜单部位手术（TU-LESS）和经阴道腹腔镜单部位手术（TV-LESS），越来越受欢迎。虽然这两种方法都取得了积极的结果，但目前直接比较 TU-LESS 和 TV-LESS 的文献有限。
本研究有两个主要目的：（1）评估 TV-LESS 和 TU-LESS 治疗卵巢囊肿的安全性和可行性；（2）比较两种手术的手术和术后结果。
这是一项对 81 例有良性卵巢囊肿诊断并适合 TV-LESS 或 TU-LESS 的患者进行前瞻性观察性临床分析。手术于 2018 年 2 月 1 日至 2020 年 1 月 31 日在一家三级医院进行。患者分为 TV-LESS（n=40）和 TU-LESS 组（n=40），因严重骨盆粘连性疾病而排除 1 例。比较了人口统计学、手术结果和随访细节。
所有 80 例患者均顺利完成手术。两组患者的人口统计学特征相匹配（除年龄外），手术时间、术中失血量、血红蛋白丢失量和住院费用无差异（P>0.05）。然而，TV-LESS 组患者的下床活动时间更快（P<0.001），肠道功能恢复时间更快（P<0.001），术后疼痛水平更低（P<0.001），住院时间更短（P<0.001）。术后 1、4 和 24 周时，TV-LESS 组的美容评分也更高。
我们的初步经验表明，TU-LESS 和 TV-LESS 均可用于卵巢囊肿切除术和输卵管卵巢切除术，且安全可行。然而，TV-LESS 可能具有以下三个主要优势：（1）术后并发症（如切口疝）较少；（2）术后疼痛较轻；（3）美容满意度提高。
