Marchand Greg J, Massoud Ahmed, Ulibarri Hollie, Arroyo Amanda, Herrera Daniela Gonzalez, Hamilton Brooke, Ruffley Kate, Robinson Mckenna, Dominick Marissa, Azadi Ali
Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Marchand, Massoud, Ulibarri, Arroyo, Herrera, Hamilton, Ruffley, and Robinson).
Faculty of Medicine, Fayoum University, Faiyum, Egypt (Massoud).
AJOG Glob Rep. 2024 Dec 15;5(1):100435. doi: 10.1016/j.xagr.2024.100435. eCollection 2025 Feb.
Ectopic pregnancy is an emergency frequently requiring laparoscopic intervention. This study aimed to determine whether single-incision laparoscopic surgery is a safe and effective treatment method compared with conventional laparoscopic surgery with multiple ports.
This study searched 6 databases from their inception to May 15, 2024, for articles comparing the safety outcomes of single-incision laparoscopic surgery with conventional laparoscopic surgery in managing women with ectopic pregnancy.
This study included all studies that evaluated the safety outcomes of single-incision laparoscopic surgery compared with conventional laparoscopic surgery in patients with ectopic pregnancy and included at least 1 of our preselected outcomes. In addition, this study included both randomized controlled trials and observational studies.
Review Manager (version 5.4.1) and OpenMetaAnalyst software were used to analyze the extracted data. In addition, this study used odds ratios for dichotomous outcomes, mean difference for continuous outcomes, a fixed effects model for homogeneous outcomes, and a random effects model for heterogeneous outcomes. Furthermore, heterogeneity was evaluated using the and values. After removing duplicates, this study identified 83 studies. Using a 2-step screening process, this study excluded non-English and animal studies and included randomized controlled trials and observational studies that included at least 1 of our preselected outcomes. Ultimately, 12 studies were included in the final synthesis.
Our analysis showed a significant favoring of the single-incision laparoscopic surgery group in the pain visual analog scale score (median difference=-0.57; <.01). However, our study found no statistically significant difference between both procedures in the times of analgesic use (median difference=-0.08; =.19), intraoperative complications (odds ratio=1.17; =.8), postoperative complications (odds ratio=1.02; =.96), conversion to laparotomy (odds ratio=1.40; =.59), bowel injury (odds ratio=1.42; =.8), and postoperative fever (odds ratio=0.52; =.42).
The use of single-incision laparoscopic surgery for treating ectopic pregnancy may reduce postoperative pain with similar rates of analgesic use. The incidences of intraoperative and postoperative complications were comparable. Furthermore, the rates of conversion to laparotomy, bowel injury, and postoperative fever were similar between the 2 techniques. Our results seem to show that single-incision laparoscopic surgery is noninferior to conventional laparoscopic surgery for the safe treatment of ectopic pregnancy.
异位妊娠是一种常需腹腔镜干预的急症。本研究旨在确定与多端口传统腹腔镜手术相比，单切口腹腔镜手术是否为一种安全有效的治疗方法。
本研究检索了6个数据库自建库至2024年5月15日的文献，以查找比较单切口腹腔镜手术与传统腹腔镜手术治疗异位妊娠女性安全性结局的文章。
本研究纳入所有评估单切口腹腔镜手术与传统腹腔镜手术治疗异位妊娠患者安全性结局且包含至少一项我们预先选定结局的研究。此外，本研究纳入随机对照试验和观察性研究。
使用Review Manager（5.4.1版）和OpenMetaAnalyst软件分析提取的数据。此外，本研究对二分结局使用比值比，对连续结局使用平均差，对同质结局使用固定效应模型，对异质结局使用随机效应模型。此外，使用I²和τ²值评估异质性。在去除重复项后，本研究识别出83项研究。通过两步筛选过程，本研究排除非英文研究和动物研究，并纳入包含至少一项我们预先选定结局的随机对照试验和观察性研究。最终，12项研究纳入最终综合分析。
我们的分析显示，单切口腹腔镜手术组在疼痛视觉模拟量表评分方面显著更优（中位数差值=-0.57；P<.01）。然而，我们的研究发现，两种手术在镇痛药物使用次数（中位数差值=-0.08；P=.19）、术中并发症（比值比=1.17；P=.8）、术后并发症（比值比=1.02；P=.96）、中转开腹（比值比=1.40；P=.59）、肠损伤（比值比=1.42；P=.8）及术后发热（比值比=0.52；P=.42）方面无统计学显著差异。
使用单切口腹腔镜手术治疗异位妊娠可能减轻术后疼痛，且镇痛药物使用率相似。术中及术后并发症发生率相当。此外，两种技术中转开腹、肠损伤及术后发热发生率相似。我们的结果似乎表明，单切口腹腔镜手术在安全治疗异位妊娠方面不劣于传统腹腔镜手术。
