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Abstract: Objective: To compare perioperative outcomes, including pain, between single-port access (SPA) and conventional laparoscopy in patients with presumed benign gynecological adnexal diseases. Study design A retrospective cohort study was performed at Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea. All operations in each group were performed consecutively by a single surgeon. Results: A total of 188 patients were enrolled, with 94 patients per group. Baseline characteristics before surgery were similar between groups. Visual analogue scale pain scores 24h after laparoscopy were lower in the SPA group than in the conventional laparoscopy group (2, 0–7 vs. 3, 2–6 P =0.006). In addition, we found that the SPA group had less supplementary analgesic use (parenteral Ketoprofen intramuscular injection, 1 ampule=100mg) per patient after surgery compared to that in the conventional group (1 ampule, 0–7 vs. 2 ampule, 0–6, P =0.010). Conclusions: These results add to the evidence suggesting an advantage of SPA laparoscopy over conventional laparoscopy in terms of decreasing postoperative pain. Additional large, randomized controlled trials are needed to confirm these findings and to investigate long-term outcomes such as quality of life and cosmesis. [Copyright &y& Elsevier]

To present our experience of modified laparoscopically assisted vaginal hysterectomy (LAVH) and to evaluate the surgical outcomes and complications. Women with benign gynaecologic tumours that underwent a modified LAVH at the Samsung Medical Centre were analysed retrospectively. The technique is primarily a vaginal hysterectomy with a minor component of the laparoscopic procedures (stage 2 laparoscopic hysterectomy (LH)) and had two modifications (vaginal anterior colpotomy and McCall culdoplasty) from the standard technique. A total of 2012 LAVH procedures were performed from January 2000 to May 2008. The mean duration of the operations and the uterine weight were 102 ± 32 min and 305 ± 168 g, respectively. In 196 (9.7%) cases, the uterine weight was more than 500 g. Conversion to laparotomy was needed in 97 cases. Major intraoperative complications occurred in 45 cases (2.2%): bladder injury, 26 (1.29%); bowel injury, nine (0.45%); haemorrhage of major vessels, nine (0.45%); and ureteral injury, one (0.05%). Major long-term complications occurred in three cases: one fistula and two trocar site herniations. Stage 2 LH combined with modified vaginal anterior colpotomy and modified McCall culdoplasty is safe and effective for benign gynaecologic tumours and the prevention of post-LAVH vaginal prolapse. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the factors associated with physicians' choice of laparotomy or laparoscopy in pregnant women with presumptive benign ovarian tumors.Methods: Retrospective comparative analysis of pregnant women who underwent laparotomy or laparoscopy for ovarian tumors and who delivered at Samsung Medical Center, Seoul, Korea, between July 1995 and April 2008.Results: Univariate analysis revealed that the following factors had a significant or a borderline significant association with the choice of operation type: maternal age (P=0.044); surgeon type (professor vs clinical fellow; P=0.094); tumor mass size (P=0.081); gestational age (P=0.035); and time since surgery (P<0.001). Multivariate analysis showed that tumor size (P=0.030), gestational age (P=0.027), and time since surgery (P=0.004) were independent factors associated with physicians' choice of laparoscopy or laparotomy for the management of presumptive benign ovarian tumors during pregnancy.Conclusions: In the latter years of the present study, physicians at the study center preferred the laparoscopic approach for managing presumptive benign ovarian tumors during pregnancy. Furthermore, they preferred this approach to laparotomy for pregnancies at a relatively early gestational age and for treating small tumors. [ABSTRACT FROM AUTHOR]