Laparoendoscopic single-site versus conventional laparoscopic gynecologic surgery: a metaanalysis of randomized controlled trials

• Published in: American journal of obstetrics and gynecology 2013-10, Vol.209 (4), p.317.e1-317.e9
• Main Authors: Song, Taejong, MD, Kim, Mi-La, MD, Jung, Yong Wook, MD, Yoon, Bo Sung, MD, Joo, Won Duk, MD, Seong, Seok Ju, MD
• Format: Article
• Language: English
• Subjects: Adnexa Uteri - surgery; Adult; Aged; Blood Loss, Surgical - statistics & numerical data; Conversion to Open Surgery - statistics & numerical data; Female; Genital Diseases, Female - surgery; gynecologic; Humans; laparoendoscopic single-site; laparoscopy; Laparoscopy - methods; Length of Stay; LESS; metaanalysis; Middle Aged; Obstetrics and Gynecology; Pain, Postoperative - epidemiology; Postoperative Complications - epidemiology; Randomized Controlled Trials as Topic; Uterus - surgery
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2013.07.004

Objective To assess the current evidence regarding the efficiency, safety, and potential advantages of laparoendoscopic single-site surgery (LESS) for treating gynecologic diseases. Study Design We comprehensively searched PubMed, Embase, and the Cochrane Library from their inception to December 2012. Two authors screened out duplicates and independently reviewed eligibility of each study. We included randomized controlled trials comparing LESS with conventional laparoscopy (CL) for treating gynecologic diseases. The primary outcomes were perioperative complication rate, conversion rate, postoperative pain, and cosmetic satisfaction. Results We included 6 randomized controlled trials with 439 participants in the final analysis. There were no significant differences between LESS and CL in terms of perioperative complication rate (15.5% and 14.3%; risk ratio, 1.11; 95% confidence interval [CI], 0.74–1.67; P  = .61), conversion rate (3.8% and 1.1%; risk ratio, 2.75; 95% CI, 0.73–10.33; P  = .13), postoperative pain (weighted mean difference [WMD], −0.22; 95% CI, −1.29 to 0.85; P  = .68), analgesic requirement (WMD, 0.41; 95% CI, −1.69 to 2.51; P  = .70), and cosmetic satisfaction (WMD, 0.19; 95% CI, −0.30 to 0.68; P  = .46). There were also no differences in terms of operative time ( P  = .65), hemoglobin change ( P  = .23), time to first flatus ( P  = .17), and length of hospital stay ( P  = .99) between both techniques. Conclusion This metaanalysis provides evidence that LESS is comparable in the efficacy and safety, but does not offer potential advantage such as better cosmesis and lesser pain compared with CL for treating gynecologic diseases.