Single-Port Access Laparoscopic Surgery in Gynecology: Technical Tips

Numerous studies have reported various laparoscopic techniques since the idea of “minimal invasive access surgery” was introduced in the early 1990s (1). One of them is the transumbilical endoscopic surgery (TUES). TUES is a single-port access (SPA) surgery approach to the umbilicus, an embryologic natural orifice (2). Other names of this technique include SPA surgery, scarless surgery, single-port laparoscopy (3), one-port umbilical surgery, natural orifice transumbilical surgery (4), laparoendoscopic single-site surgery (LESS) (5), and embryonic natural orifice transumbilical endoscopic surgery (6). Recently, with improvements in surgical expertise with optimal instrumentation, the interests of minimally invasive surgery have increased. As a result, many surgeons have tried to reduce the number and size of ports in laparoscopic surgery for reducing morbidity and better cosmetic outcome. It has been reported that SPA surgery has less postoperative pain compared to conventional laparoscopy in the gynecologic field (7). In addition, SPA surgery is expected to offer better cosmetic results and to reduce operative complications related to the trocar insertion as it involves less inserted trocars (8). However, SPA surgery has systemic limitations, including crashes between instruments or between instruments and endoscope, a limited number of instruments, an unstable camera platform, and the limited mobility of straight laparoscopic instruments because surgical instruments work through only one port. These technical problems cause lower accuracy of the operation and longer operation time compared to conventional laparoscopy. To overcome the technical difficulties, newly developed instruments, including an angled laparoscope or instrument have been introduced. However, there are limitations for popular use of SPA surgery, including high cost. Therefore, we suggest useful surgical techniques for SPA surgery using conventional laparoscopic instruments.