Abstract
Objective:
Minimally invasive surgery is rapidly developing and widely used, but the difficulty of laparoscopic endoscopic single-site surgery (LESS) poses a challenge to many surgeons. We aim to enrich the study of the learning curve of LESS application in adnexectomy surgery so as to provide more information support for surgeons.
Methods:
The medical records of 369 patients who underwent LESS of benign adnexal masses from January 2018 to December 2023 were reviewed by a chief physician from Zhongda Hospital affiliated to Southeast University. The medical records of patients who underwent conventional laparoscopic surgery of benign adnexal masses in the same period were collected in a ratio of 1:2. After collecting data according to the standards of waste and discharge, the learning curve of LESS was drawn, and the differences in objective outcomes between LESS and conventional multisite laparoscopy were compared.
Results:
All 101 patients underwent successful surgery. In the LESS group, the median operation time was 65 (55–80) min, and the median diameter of the tumor was 7 (5–8) cm. The fitting curve equation was y (R2 = 0.743), the median postoperative hospital stay was 4 (3–5) days, the average postoperative hemoglobin decrease was 18.49 ± 11.12 g/L, the median postoperative leukocyte increase was 1.04 (−0.04, 2.55) × 109/L, the postoperative ambulation time was 1 day, and the postoperative exhaust time was 2 days. Two groups were compared in 284 patients. The median intraoperative blood loss in the LESS group was 25 (20, 50) ml, which was higher than that in the conventional laparoscopy (CL) group (20 [10, 50] mL, p = 0.03). The median postoperative hemoglobin decrease in the LESS group was 20 (12, 27) g/L, which was also higher than that in the CL group (15 [7, 20] g/L, p = 0.01). The white blood cell count in CL group increased by 0.98 [−0.51, 2.12] × 109/L, which was significantly higher than that in LESS group (−0.99 [−2.04, 0.11] × 109/L, p < 0.05). There was no significant difference in operation time (p = 0.74) and total postoperative hospital stay (p = 0.85).
Conclusion:
After 57 or more cases of surgical training, the surgeon can cross the learning curve to meet the surgical requirements and be more skilled in performing LESS of adnexal masses. There is no significant difference in overall patient benefits between transumbilical LESS and CL, but the inflammatory response after LESS is lower, and LESS has important advantages in the resection of accessory masses.
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