Abdominal, multi-port and single-port total laparoscopic hysterectomy: eleven-year trends comparison of surgical outcomes complications of 936 cases.

Purpose: To compare surgical outcomes and complications of 284 patients who had total abdominal hysterectomy (TAH), 366 patients who had multi-port access total laparoscopic hysterectomy (MPA-TLH), and 286 patients who had single-port access total laparoscopic hysterectomy (SPA-TLH) using a transumbilical single-port system.

Methods: A retrospective study was conducted on a cohort of women who underwent TAH, MPA-TLH, or SPA-TLH for benign gynecologic diseases at DaeJeon St. Mary's Hospital, between January 2003 and December 2013. Surgical outcomes and complications were compared between the three groups.

Results: The total operative time (min) was longest in the SPA-TLH group (188.3 ± 51.3), followed by the TAH (176.4 ± 47.9) and MPA-TLH (149.3 ± 59.5) groups (p < 0.05). The estimated blood loss (mL) did not differ between MPA-TLH and SPA-TLH (163.8 ± 168.9 vs. 176.9 ± 197.8 mL), but it was the greatest in TAH (427.1 ± 250.6, p < 0.05). The weight of the uterus (gm) was highest in TAH (375.8 ± 380.1, p < 0.05) and similar in MPA-TLH and SPA-TLH (10.1 ± 2.6 vs. 9.7 ± 2.6 cm). The hospital stay (days) was longest in the TAH (7.0 ± 2.1) and SPA-TLH (6.3 ± 2.0) groups, followed by the MPA-TLH (5.5 ± 2.0) group (p < 0.05). The major complication rate was 2.5 % (7 cases) in the TAH group, 5.5 % (20 cases) in the MPA-TLH group, and 0.7 % (2 cases) in the SPA-TLH group. In the MPA-TLH group, the complication rate of the first half of the cases was significantly higher than in the latter half of cases, especially with regards to vaginal cuff dehiscence (p < 0.05). In the SPA-TLH group, no statistically significant difference was found between the two sub-groups.

Conclusions: Our study showed that MPA-TLH and SPA-TLH were feasible and safe when compared to TAH. Furthermore, after acquiring technical skills in laparoscopic surgery, conversion from MPA-TLH to SPA-TLH might be easier than the initial conversion from laparotomy to laparoscopy. The advantage of SPA-TLH over MPA-TLH is questionable, considering the longer learning curve; however SPA-TLH is an effective alternative for both the patient and surgeon.