Laparoendoscopic Single-Site Total Laparoscopic Hysterectomy: Clinical Factors that Affect Operative Times and Techniques to Overcome Difficulties.

Study Objective: To compare surgical outcomes of patients who underwent laparoendoscopic single-site total laparoscopic hysterectomy (LESS-TLH) with operative times < 150 minutes and ≥150 minutes to determine the clinical factors that influence operative times. We also describe techniques that help overcome difficulties involved in this procedure.

Design: Retrospective study (Canadian Task Force classification II-2).

Setting: University medical center.

Patients: Two hundred thirty-four patients underwent LESS-TLH for benign uterine disease and cervical disease between September 2011 and February 2015. Thirty-seven patients (15.8%) were excluded from analysis. One hundred ninety-seven patients were divided into 2 groups according to the total operative time (median, 150 minutes): <150 minutes (n = 93) and ≥150 minutes (n = 104).

Interventions: LESS-TLH was performed using anterior, lateral, and posterolateral colpotomy techniques, and knife-in-bag morcellation was used for specimen extraction.

Measurements And Main Results: Patient characteristics, except for body mass index (BMI) and age, were generally similar in the 2 groups. Age, BMI, adhesiolysis, time to completion of colpotomy, stump repair time, specimen extraction time, blood loss, and weight of the uterus showed statistically significant differences between the 2 groups. Clinical factors that affected operative time were adhesiolysis of the posterior uterus (p = .010), time to completion of colpotomy (>65 minutes; p = .000), specimen extraction time (>34.4 minutes; p = .000), and weight of the uterus (>270 g; p = .015). Conversion to additional port laparoscopy occurred in 14 patients (5.98%). Conversion to laparotomy occurred in 1 patient (.43%). The surgical complication rates were 3.2% (3 patients) in the <150 minutes group and 3.8% (4 patients) in the ≥150 minutes group. No urologic injuries occurred in either group. One postoperative ileus occurred in the ≥150 minutes group; it was relieved by conservative treatment.

Conclusion: Time to completion of colpotomy was influenced by adhesiolysis of the posterior uterus and specimen extraction time by weight of the uterus. Alternative methods for decreasing the time required to extract a large uterus and for approaching posterior adhesion of the uterus are needed for LESS-TLH.