Laparoendoscopic Single-Site Surgery With Hysterectomy in Patients With Prior Cesarean Section: Comparison of Surgical Outcomes With Bladder Dissection Techniques.

Abstract: Study Objective: The aim of this study was to compare operative outcomes from 300 patients who underwent laparoendoscopic single-site surgery (LESS) with hysterectomy (H) according to previous cesarean section and to describe the bladder dissection technique in detail. Design: Retrospective cohort study (Canadian task classification II-2). Setting: A university hospital, research hospital, and a tertiary care center. Patients: In total, 300 LESS-H procedures were performed for benign gynecologic disease, cervical disease, and endometrial disease at Samsung Medical Center in Seoul, Korea, between May 2008 and February 2012. Patients were categorized into 2 groups according to previous cesarean history: the previous cesarean section group (n = 98) and the no history of previous cesarean section group (n = 202). Intervention: LESS-H with vaginal or lateral approach for bladder dissection. Measurements and Main Results: Baseline demographics and clinical characteristics, except for age, were generally the same between the 2 groups. The operative outcomes including operative time, uterine weight, estimated blood loss, hemoglobin change, hospital stay, and transfusion rate were not different between the 2 groups. Adhesiolysis was required more in the previous cesarean section group (p = .002). LESS failure requiring additional trocars occurred more often in the previous cesarean section group (p = .041), but the rates of conversion to laparotomy were not different (p = .327). The overall surgical complication rate except transfusion was 2.67% in this study. Two cases of urologic problems with ureter injury or bladder injury were reported in the previous cesarean section group. In the no previous cesarean section group, there were 2 urologic problems. Conclusion: LESS-H is a feasible procedure with a lateral approach or vaginal approach for bladder dissection, even in patients with previous cesarean section. [Copyright &y& Elsevier]