الفهرس 
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Abstract
L
aparoscopic surgery has become the standard of care for many abdominal and pelvic surgeries. Several studies have proved that the laparoscopic approach to various benign and malignant conditions has resulted in decreased morbidity, shorter hospital stay, improved surgical outcomes, and improved quality of life when compared with conventional surgeries.
Although laparoscopy has decreased the morbidity directly related to a surgical approach, each working port carries an inherent risk of bleeding, infection, concomitant organ damage, hernia formation, and decreased cosmetic outcome. Advances in surgical instrumentation and design have allowed minimal access surgery to become even more minimal.
In surgical treatment of ovarian cysts, single port access laparoscopic surgery has also been reported as an alternative procedure to conventional laparoscopic ovarian cystectomy or oophorectomy, as far as surgical outcome is concerned.
In this study, we aimed to evaluate the postoperative consequences of laparo-endoscopic single site surgery relative to conventional laparoscopy in presumed benign ovarian cyst.
This randomized controlled trial was conducted at tertiary care hospital at Ain Shams University hospitals from January 2021 to December 2022 and performed on total 70 patients who presented with benign ovarian pathology.
The current study revealed that there was no statistically significance difference between LESS and Multiport group as regards demographic characters (age, BMI, parity, and history of previous laparotomy).
Cesarean section was the most common cause of previous abdominal surgery (57.8% vs 53%), followed by appendectomy (26.4% vs 35.3%) respectively in both groups with no statistically significance difference as regards past surgical history between the two groups.
As regards the Postoperative pain score (VAS score), the current study results revealed that there was no statistically significant difference between the two groups in the 6 hours, 12 hours, and 24 hours VAS pain score.
Consequently, the consumption of additional analgesics (ketolac, 10 mg/tablet) during the first postoperative week was non-significantly lower in LESS group compared to the Multiport group.
In spite of this difficulty, laparoscopic ovarian cystectomy using the single port in LESS group was successful in 35 patients with only 2 cases (5.7%) of additional port insertion due to extensive pelvic adhesions, while in the conventional multiport group no additional port was needed
As regards the operative data, our study results revealed that the operative time was (49.3 ± 15 min) and (41.8 ± 18 min) and the operative blood loss was (78 ± 20 ml) and (69 ± 18.5 ml) in LESS group and Multiport group respectively, with no statistically significant difference in either the length of the operation in minutes or the amount of blood loss in mL between the two groups.
Consequently, there was no statistically significant difference between the group in the pre-operative, post-operative and the DROP in Hb values.
In our study, the operative time was significantly shortened during a period of 3 months (less than 10 cases) from 60 minutes to 30 minutes without special equipment or training. Therefore, there is a shorter learning curve for LESS laparoscopy based on our operative results.
As regards the hospital stay, almost all the patients in both groups were discharged at 1 day after the operation (91.4% in LESS group versus 82.9% in Multiport group). The longer hospital stay in both groups was related to postoperative ileus (1 patients: 2.9% in LESS group versus 2 patients: 5.7% in multiport group) with no statistically significance difference between the two groups in the postoperative hospital stay.
As regards the operative complications, our study results revealed that the intraoperative complications were in the form of one case of extraperitoneal insufflation in the Multiport group, while bowel injury, vascular injury, or the need for blood transfusion did not occur in either group.
Our study results revealed that there was no significance difference in cosmetic outcome on day one in the median score of LESS group compared to multiport group (14.3 versus 14.9).
The median score at 7 days after discharge were significantly lower in the LESS group compared to Multiport group, indicating better objective and subjective cosmetic outcomes in the LESS group.
We concluded that LESS technique for ovarian cystectomy is feasible, safe, and equally effective compared to the conventional technique with a short learning curve. Potential benefits are sought in decreasing port related morbidity, patient satisfaction, and cosmetic satisfaction. However, it should be aware that in up to 5.7% of LESS procedure, an additional port is needed, and superficial wound infection occurred.
As the differences in the outcomes between the two groups were small, further studies are warranted with a larger sample size, more advanced gynecological surgeries, and longer follow up to define the benefits of LESS.
We recommend that LESS technique could be as effective and safe as conventional multiport laparoscopy and associated with better patient satisfaction. LESS technique should be included in the training programs of basic laparoscopic surgeries.