Transvaginal Versus Transumbilical Laparoscopic Single-Site Surgery for Management of Benign Adnexal Masses: A comparative Study

ABSTRACT

Objective. Transvaginal laparoendoscopic single-site surgery (TV-LESS) was recently suggested as a less invasive approach than conventional laparoscopic approaches.
Aim of our study. was to compare between TU-LESS and TV-LESS in specimen extraction in patients with benign adnexal masses who underwent minimally invasive surgery as regard; safety and feasibility of the procedures, operative findings and post-operative outcomes.
Patients and methods. Prospective analysis of collected data of 100 patients that underwent TU-LESS and TV-LESS salpingo-oophrectomy, oophorectomy or ovarian cystectomy at Gynecology and obstetrics department, Zagazig University hospitals from January 1, 2020 to January 30, 2023. We randomly divided included patients in to 2 groups according performed surgical approach. The TU group included 50 patients who underwent extraction of the excised specimen through the umbilicus. The TV group included 50 patients who underwent extraction of the excised specimen through the vagina.
Results. There is statistically significant relation between approach used and all of ovarian volume, operative time, intraoperative bleeding, return to bowel function, ambulation time (all are significantly higher in TU-LESS), postoperative 12-hour VAS cosmetic score (significantly lower in TU-LESS) and postoperative analgesic ampoules (significantly higher in TU-LESS)
There is statistically non-significant relation between approach and any of studied parameters.
Specimen extraction in TV-LESS group caused less postoperative pain than the TU-LESS group.
The overall cosmetic satisfaction was higher in TV-LESS group when compared with the TU-LESS group 3 months after the surgery (P = 0.02).
Conclusions. We showed that performing TV-LESS has major advantages over TU-LESS: (1) Lower incidence of postoperative complications as umbilical hernia; (2) Lower incidence of postoperative pain (3) earlier bowel functions return and shorter time of hospital stay; and (4) higher cosmetic appearance.