Laparoendoscopic single-site (LESS) surgery in gynecology: Current status and future directions

Abstract

Background: The shift from open surgery to operative laparoscopy brought on one of the greatest transformations in the history of surgery. Advancements in surgical instruments, optics, and ports have allowed the development of single port laparoscopy, or laparoendoscopic single-site surgery (LESS). Results: LESS can be used for salpingostomy or salpingectomy to treat tubal ectopic pregnancy. ESS could be used to treat benign and malignant adnexal disease, and for hysterectomy. For adnexal disease, LESS can be used to remove ovarian cysts, salpingo-oophorectomy, to remove endometriosis, and remove malignant masses. Single-port access subtotal hysterectomy is more commonly used now, with various advancements in place to overcome the limited free movement and technical difficulty. Robotic LESS has been used in gynecology for bilateral salpingo-oophorectomy and total hysterectomy. Conclusions: The use of LESS in gynecologic surgery is expanding. It has the advantages of reduced postoperative pain, earlier return to daily activities, reduced incidence of port-site hernias and hemorrhage, and improved cosmesis and patient satisfaction.

Keywords

• Laparoendoscopic single-site gynecological surgery (LESS)
• Natural orifice transluminal endoscopic surgery (NOTES)
• TriPort system
• Single-port laparoscopy (SPL)