Gynecologic Laparo-endoscopic Single-Site Surgery: Where do we Stand and what is on the Horizon?

Objective: The objective of this article is to review the current literature on laparo-endoscopic single-site (LESS) surgery in gynecology, discuss recent developments, and what is on the horizon for LESS surgery.

Design: Appraisal of articles published on the use of laparo-endoscopic single-site surgery in gynecology from 2008 to the present. PubMed, Medline, and the Cochrane Central Register of Controlled Trials were systematically searched using the terms “laparo-endoscopic single-site”, “single-site laparoscopy”, “single port laparoscopy”, “SPA”, “SILS”, “LESS”, “robotic single-site surgery”, and “R-LESS” between January 1, 2016 and February 15, 2016. Publication date restrictions were all publications 2008 and later. Non-English language was excluded.

Results: LESS and R-LESS is safe, feasible, and equivalent to traditional multiport laparoscopy and robotic surgery. Cosmesis is potentially the most obvious advantage associated with LESS surgery. Instrument crowding with associated external instrument space conflicts is a major problem since all the instruments are inserted through a single point on the abdomen. For the experienced laparoscopist, the learning curve for LESS is shorter and associated with less morbidity when compared to the learning curve of multiport laparoscopy.

Conclusion: LESS surgery is another option of approach to minimally invasive gynecologic surgery. There is a clear body of literature demonstrating that LESS is feasible, safe, and equivalent to traditional multiport and robotic surgery. There is growing literature regarding improved cosmesis, improved pain control, quicker recovery, and shorter hospitalizations but these studies, even when combined, are underpowered. Both traditional and robotic laparoendoscopic single site surgeries are still in the early development and diffusion.