SUCCESSFUL TRANSITION FROM MULTI-PORT TO SINGLE-PORT FOR LAPAROSCOPIC HYSTERECTOMY IN THE TREATMENT OF SYMPTOMATIC LEIOMYOMA AND/OR ADENOMYOSIS USING ARTISENTIAL® WRISTED ARTICULATED INSTRUMENT; AN OBSERVATIONAL COHORT STUDY - COGI 2023 The 31st World Congress on Controversies in Obstetrics, Gynecology & Infertility

Problem statement

Because of the technical difficulty of single-port surgery, many gynecologic laparoscopists have yet to adopt the single-port approach for laparoscopic hysterectomy (LH). This study aims to compare the outcome of hysterectomy before and after the transition of the primary mode of LH from multi-port to single-port.

Methods

This study is an observational cohort study subjecting all women who underwent hysterectomy by a single surgeon with an indication of symptomatic leiomyoma and/or adenomyosis. The cohort was divided into three groups for analysis; pre-transition (Oct 2018 ~ June 2020), transition (July 2020 ~ Feb 2022), and post-transition (March 2022 ~ March 2023). The vaginal cuff was closed intracorporeally using an articulating needle holder, ArtiSential® (LIVSMED Inc., Republic of Korea), in single-port LH in the post-transition period. Surgical outcomes and complications were compared between the three groups. Single-port LH in the post-transition period was compared with multi-port LH in the pre-transition period.

Results

A total of 196 patients were enrolled in this study (61, 70, and 65 patients in the pre-transition, transition, and post-transition periods, respectively). The primary surgical mode dramatically changed (86.9% for multi-port LH in the pre-transition period and 92.3% for single-port LH in the post-transition period), and the laparotomy rate decreased (11.5%, 8.6%, 6.2% in each period) over time. Among patients receiving LH, additional port insertion and open conversion rates were 5.7% and 0% in the pre-transition period and 1.7% and 3.3% in the post-transition period. Vaginal cuff dehiscence and serious complication rates were not different among the three groups (Table 1). In comparing the single-port LH group in the post-transition period with the multi-port LH group in the pre-transition period, the length of stay decreased significantly (2.0 ± 0.5 days vs. 2.9 ± 0.4 days, p<0.001), while uterine weight, surgical time, estimated blood loss, and complication rates were not statistically different.

Table 1

Conclusion

Our study showed that the primary mode of hysterectomy had been successfully switched from multi-port to single-port after some transition period. The technical difficulty and stableness of intra-corporeal cuff closure might benefit from using an ArtiSential® needle holder.