Single-Port Access Laparoscopic Hysterectomy: A Literature Review

Background: Minimally invasive surgery has a central role in managing benign and malignant conditions in gynecology patients. While laparoscopy decreases morbidity directly related to the surgical approach, each working port used carries an inherent risk of bleeding, infection, concomitant iatrogenic visceral injury, hernia formation, and a less-satisfactory cosmetic outcome. Single-port access laparoscopy (SPAL) is either a single fascial-incision site with a single trocar with multiple ports or the use of either a single skin-incision site with multiple fascial incisions with individual trocars. Use of SPAL may be important for limiting some of the undesirable sequelae of the use of multiple ports. Objective: The purpose of this systematic review was to evaluate the feasibility, safety, and efficacy of SPAL hysterectomy. Materials and Methods: A literature search in PUBMED from 2008 to January 2014 was performed, using the key words single port hysterectomy, laparoendoscopic hysterectomy and single site hysterectomy. Results: Recently used port systems are discussed along with the advantages and disadvantages of the SPAL technique, and the indications and contraindications for use of the technique. Conclusions: SPAL hysterectomy appears to be a technically feasible, safe, and effective procedure for managing symptomatic patients who have been diagnosed with leiomyoma or adenomyosis, with a uterine size < 16 weeks of gestation or weight of < 560 g.