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WJOLS
Recent Advances in Laparoscopic Hysterectomy: Journey from Multiple Incision to Single Incision Hysterectomy
REVIEW ARTICLE
Recent Advances in Laparoscopic Hysterectomy:

Journey from Multiple Incision to Single Incision

Hysterectomy

Sweta Tiwari
Member World Association of Laparoscopic Surgeons, Consultant Gynecologist and Laparoscopic Surgeon, World Laparoscopy
Hospital, Cyber City, DLF Phase II, Gurgaon, Haryana, India

Abstract
Four different approaches for hysterectomy are possible: through laparotomy; via the vagina; with the help of laparoscopy using several
small incisions; and by single incision laparoscopic surgery. Currently, around 70 to 90% of hysterectomies are carried out via abdominal
incision. This article compares the outcome of LAVH with SILS. In the SILS hysterectomy, only a single small incision in the belly button
is created for insertion of the surgical instruments. The entire hysterectomy is performed using the SILS Port allows for the removal of the
uterus through a small incision which measures only 20 mm. Compare to laparoscopic assisted vaginal hysterectomy recovery from the
SILS hysterectomy is similar to the 2 weeks; however, laparoscopic hysterectomies may require multiple incisions which has less
cosmetic value. Technological advances in SILS, including those in port structure, will enable gynecologists in future to employ strategies
that effectively enhance instrument coordination and suturing. However; benefits of SILS to the patient need to be further documented
prospectively before it can be recommended widely for every gynecologist to perform.
Keywords: Single incision laparoscopic surgery (SILS), laparoscopic assisted vaginal hysterectomy (LAVH), operative outcome in LH,
pain, operative time in TLH, length of stay after hysterectomy.

INTRODUCTION School, Izmir, Turkey and first presented at—The Annual
The benefits of surgical treatment of disease have always Congress of Turkish Association of Paediatric Surgeons,
been viewed as being obtained with a certain acceptable October 2005. SILS has the advantage of improved
level of pain and trauma to the patient. Minimizing this cosmesis, ease of tissue retrieval, increased patient
untoward effect of any surgical procedure has been a driving acceptance (Figs 1 and 2). Whether it causes less pain or
force of laparoscopy since its inception in the early 1900s. 1,2 early recovery needs further trials.
Even with the clear benefits of laparoscopy over open Single incision laparoscopic surgery (SILS) refers to
3
surgery, we have continued to see a trend toward fewer performing laparoscopy through a single incision. This
invasions in the quest for “scarless” surgery. approach is also referred to as single access surgery (SAS),
Laparoscopic assisted vaginal hysterectomy (LAVH) single port surgery (SPS), single port access (SPA), single
was first performed by Reich in the year 1989. It has been port laparoscopy (SPL) and one port umbilical surgery
implemented in hysterectomy procedures for uterine (OPUS).
myomas and adenomyomas. Three or four laparoscopic SILS has several other advantages compared with
ports are traditionally required to complete a LAVH. One conventional multiple incision laparoscopic hysterectomy.
port is inserted through the infraumbilical, and the other First, operative complications related to trocar insertion such
ports are usually inserted through the lateral abdominal wall as epigastric vessel injury, operative wound infection, and
4
muscles, suprapubis, or both. To minimize minimally hematoma and visceral organ damage might be avoided by
invasive surgical techniques such as LAVH, single-port- reducing the number of ancillary ports penetrating abdominal
access (SPA) laparoscopic surgery has been developed. 5-7 wall. In particular, bleeding from epigastric vessels is one
of the major complications after laparoscopic surgery.
SILS AN EMERGING ALTERNATIVE Inferior epigastric vessels course cephalad from the
FOR HYSTERECTOMY external iliac vessels in the lateral third of the rectus
SILS was first performed for the treatment of appendicitis abdominis. Injury of these vessels occurs, when the
at Department of Pediatric Surgery, Dokuz Eylul Medical ancillary trocars were inserted through the lower quadrant

World Journal of Laparoscopic Surgery, May-August 2010;3(2):67-74 67