Page 19 - WJOLS - Laparoscopic Journal

Sweta Tiwari

DISCUSSION of this study show that the operative outcomes, including
SILS has gained lot of attention around the world. Several operative time, hospital stay, and EBL, in the SPA-LAVH
controlled trials have been conducted; some are in favor of group were comparable to those of the conventional LAVH
SILS. The goal of this review was to ascertain that if the group. In addition, pain after surgery was lower in the SPA
SILS is superior to multiple incisions, and if so what are the group than in the conventional group. The SPA technique
benefits and how it could be instituted more widely. There has been improved and might be adequate for gynecologic
is also diversity in the quality of the randomized controlled surgery. 13-16
trials. The main variable in these trials are following In another study, Takahiro Koyanagi et al compared
parameters: outcomes of single-incision LAVH vs conventional multiport
• Number of patients in trial LAVH. The mean operative time was 76 ± 15.5 vs
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• Withdrawal of cases 71.4 ± 21.7 min (P = 0.57). The mean weight of resected
• Exclusion of cases uterus was 366.3 ± 144 vs 354 ± 95.5 gm (P = 0.85). BMI
• Blinding was 23.3 ± 2.75 vs 22.2 ± 3.76 kg/m (P = 0.52). No
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• Intention to treat analysis significant difference was observed between single-incision
• Publication biases and conventional LAVH. They concluded that single-incision
• Local practice variation LAVH can be undertaken safely and with similar operative
• Prophylaxis antibiotic used results to conventional multiport LAVH. They considered it
• Follow-up failure.
a promising alternative method for the treatment of some
Without proper attention to the detail of all the parameters patients with uterine myomas as incision-free gynecological
it is very difficult to draw a conclusion. It has been found operation.
among the gynecologist that there is a hidden competition Erica R Podolsky et al went for a 24 months follow-up
between the gynecologist performing SILS and the surgeons of novel laparoscopic approach utilizing standard
who are still doing multiple incision surgery, and this instrumentation. They demonstrated that SPA surgery is
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competition influences the result of study. One should an alternative to multiport procedures with proposed initial
always think of SILS and multiple incision laparoscopic benefits of decreased number of incisions and improved
hysterectomy as being complimentary to each other. cosmesis for the patient. Long-term prospective randomized
A successful outcome requires greater skills from the
operator. The result of many comparative studies have large case series will be necessary to assess pain, recovery,
shown that outcome of SILS was influenced by the and hernia formation proving advantages, if any, over
experience and technique of the operator. SILS requires multiport laparoscopy. Another retrospective study showed
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different skills and technological knowledge. Gynecologist an improved pain benefit.
should perform the procedure with which they are more The results of the study of Yong Wook Jung et al
comfortable. revealed that for SILS median operative time was 100 min
In a study, done by Tae-Joong Kim et al, a retrospective (57-155 min), median blood loss was 100 ml (10-400 ml),
case-control study comparing 43 SPA-LAVHs (cases) and median postoperative hospital stay was 3 days (2-6 days),
43 conventional LAVHs (controls). SPA was associated and there were no operative complications including
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with reduced postoperative pain. VAS-based pain scores transfusion. VAS scoring of operative pain at 6, 24, and
24 hours (SPA, 2.5 ± 0.7; conventional, 3.5 ± 0.8; p\0.01) 48 hours after surgery was 4, 3, and 2, respectively.
and 36 hours (SPA, 1.7 ± 1.2; conventional, 2.9 ± 1.1; Although there was a case that required a conversion to
p\0.01) after surgery were lower for the SPA group. two-port TLH, they performed 29 cases of hysterectomy
However, the pain scores 12 hours after surgeries were not without any operative complications using the single-port
different between the groups. They concluded that SPA- approach. In terms of surgical outcomes and operative
LAVH has comparable operative outcomes to conventional complications including pain scores, their data were
LAVH and the postoperative pain was decreased significantly comparable to those of other investigators who evaluated
in the SPA group 24 and 36 hours after surgery. The results the feasibility of TLH using three or four ports.

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