Abstract:

Objective: To investigate the surgical techniques for transumbilical laparoendoscopic single-site surgery (TU-LESS) for resection of benign ovarian tumors using conventional instruments. Methods: A retrospective analysis was conducted on the clinical data of patients who underwent TU-LESS for benign ovarian tumors at the Women and Children′s Hospital of Ningbo University from June 2023 to June 2024. The data included the patients′ age, tumor maximal diameter, tumor type, intraoperative blood loss and operation time. The surgical videos of these cases were reviewed to summarize the relevant surgical techniques, and the relationship between the surgical techniques and the surgical outcomes was further analyzed. Results: A total of 24 patients underwent TU-LESS, and all operations were successfully completed. Among them, 3 cases required an additional auxiliary port. No organ injury, conversion to open surgery, postoperative incision infection, bleeding or umbilical hernia occurred in all patients. The average age of the patients was (26.6±7.2) years, the average operation time was (81.5±13.7) minutes, and the average intraoperative blood loss was (46.6±15.1) mL. The 24 patients were divided into two groups according to the chronological order of the operations. The operation time of the latter 12 patients was significantly shorter than that of the former 12 patients [(87.9±14.1) minutes vs. (75.2±10.3) minutes, t=2.527, P=0.019]. However, there were no statistically significant differences in intraoperative blood loss, postoperative exhaust time, and hospital stay between the two groups (all P>0.05). Video analysis indicated that establishing an effective operating triangle was the most crucial step in single-port laparoscopic surgery, which could be achieved by forming a small operating triangle, a cross-triangle, or adding an auxiliary port. Conclusions: TU-LESS for resection of benign ovarian tumors has the advantages of minimal trauma and high aesthetic degree, and can be performed using conventional laparoscopic instruments. However, surgeons need to learn and master the relevant techniques, especially the method of establishing an effective operating triangle under the laparoscope, to shorten the learning curve and reduce the occurrence of complications.

Key words: Laparoscopes, Ovarian neoplasms, Transumbilical laparoendoscopic single site surgery, Surgical technique, Manipulation triangle