Comparative analysis of laparoendoscopic single-site surgery and versus conventional laparoscopic surgery in adnexectomy: A systematic review and metaanalysis of surgical outcome.

Although the removal of the adnexa technically removes more tissue, it may require less fine manipulation and dissection than cystectomy. Secondary to this, we sought to measure the effectiveness and safety of laparoendoscopic single-site surgery (LESS) versus conventional laparoscopy (CLS). We search six databases to find studies comparing LESS and CLS for ovarian lesions where removal of the entire ovary, with or without the fallopian tube, is necessary. Criteria used for study eligibility: both controlled trials and observational studies were included in this analysis. Study appraisal and synthesis methods: we used the Cochrane risk of bias assessment tool for the randomized clinical trials and the national heart, lung, and blood quality assessment tools for the observational studies. The statistical analysis was done using the review manager software. LESS showed a significantly longer operative time [mean difference (MD)=2.96 (-1.97, 7.90), p=0.24], but with moderate heterogeneity. Estimated blood loss was significantly lower for LESS [MD=-18.62 (-33.83, -3.42), p=0.02]. The length of patient hospital stay was comparable [MD=-0.02 (-0.50, 0.47), p=0.95]. Visual analog scale (VAS) pain scores at 24 hours [MD=0.23 (-0.09, 0.56), p=0.16] and 6 hours postoperatively [MD=0.15 (-0.04, 0.33), p=0.12] were similar. The LESS group required less postoperative analgesia [risk ratios (RR)=0.47 (0.32, 0.68), p=0.001]. The change in hemoglobin was comparable [MD=-0.11 (-0.26, 0.03), p=0.14]. Perioperative complications were higher in the LESS group [RR=2.236 (1.031, 4.851), p=0.04]. Compared with CLS, LESS required more operative time but resulted in significantly less blood loss and lower postoperative analgesic use. Hospital stays and VAS pain scores were similar. LESS had a higher incidence of perioperative complications, which questions the feasibility of its use in some situations.