Most adnexal masses are incidental findings during pregnancy and usually resolve spontaneously. However, pregnancy complicated by a giant ovarian mass is rare, and surgical intervention is recommended when the mass exceeds 10 cm in diameter or persists during the pregnancy. Traditional laparoendoscopic surgery often requires extended periods of pneumoperitoneum, and the need for an initial blind puncture increases the risk of damaging the pregnant uterus and ovarian mass. With advancements in transumbilical laparoendoscopic single-site surgery, operating through an umbilical incision minimizes the potential harm associated with traditional laparoscopy, enhancing the safety of both the mother and fetus. Most literature reports operations conducted during the second trimester when the size and position of the uterus and placenta are optimal, ensuring stable placental function and a low risk of complications such as abortion or preterm birth. As the pregnancy progresses into the third trimester, the uterus moves approximately three transverse fingers above the umbilicus, making it extremely difficult to access a ruptured ovarian mass located posterior to the uterus using single-port laparoscopy. Nevertheless, with continuous improvements in transumbilical laparoendoscopic single-site surgery techniques, as well as the combination of long and short surgical instruments, it is feasible to address the rupture of a giant ovarian mass during the third trimester. Few reports currently detail the use of transumbilical laparoendoscopic single-site surgery for adnexal masses in the third trimester. This report presents a case completed at our hospital. We report the case of a giant ovarian tumor identified by ultrasound in the first trimester of pregnancy in a 27-year-old woman. Due to signs of threatened abortion, conservative treatment was chosen to allow the pregnancy to continue. The giant ovarian mass ruptured at 28+2 weeks of gestation, and it was successfully managed using transumbilical laparoendoscopic single-site surgery. The patient achieved a successful pregnancy, delivering at 38+5 weeks via emergency cesarean section due to oligohydramnios. We followed up with the mother and newborn for nearly 12 months, and they were healthy. Routine abdominal or vaginal ultrasound examinations before pregnancy are essential when a giant ovarian mass is detected in the first trimester. This helps prevent complications such as mass rupture, torsion, and adverse fetal outcomes. If surgical intervention is deemed necessary, the second trimester is generally the most appropriate time for evaluation. By this stage, the size and position of the uterus and placenta are stable, the placental function is sound, uterine sensitivity is lower, and the risk of miscarriage, premature birth, and other complications is reduced. For pregnant women with giant ovarian masses who exhibit signs of abortion in the second trimester and do not opt for surgical treatment, transumbilical laparoendoscopic single-site surgery can be considered the preferred method for addressing a mass rupture in the third trimester.
Chronic postoperative pain and recurrence are relevant complications after inguinal hernia repair. Biological meshes have been proposed as a resorbable alternative to synthetic implants that may reduce postoperative pain. To compare postoperative pain and recurrence rates between biological and synthetic meshes in laparoendoscopic inguinal hernia repair using a self-controlled design. The Biological vs Synthetic Mesh in Laparoendoscopic Inguinal Hernia Repair (BIOLAP) trial was a multicenter, randomized, self-controlled clinical trial conducted between August 2017 and February 2021 across 21 certified German hernia centers. A total of 491 adult patients with primary bilateral inguinal hernias underwent laparoendoscopic repair using 1 biological mesh and 1 synthetic mesh. Data analysis was performed from July 2023 to June 2024. Patients were randomized to receive a biological or synthetic mesh on the right side; the contralateral side received the alternate material. All patients underwent standardized laparoendoscopic repair (transabdominal preperitoneal plasty or total extraperitoneal plasty), and both patients and assessors were blinded to mesh assignment. The coprimary outcomes were pain intensity at 6 months (measured using the visual analog scale) and hernia recurrence at 2 years. Secondary outcomes included seroma, hematoma, surgical site infection, and patient satisfaction. Among 491 patients (mean [SD] age, 58.5 [14.1] years; 457 [93.1%] male), there was no significant difference in pain at 6 months between biological and synthetic meshes (mean [SD] visual analog scale score at rest, 0.3 [0.9] for both; P = .76). However, the 2-year recurrence rate was significantly higher for biological meshes (53 recurrences [11.2%]) compared with synthetic meshes (12 recurrences [2.5%]) (P < .001). Seroma rates were also significantly higher with biological meshes than with synthetic meshes (164 patients [33.4%] vs 106 patients [21.6%], respectively; P < .001). Biological meshes did not reduce postoperative pain but were associated with significantly higher recurrence and seroma rates compared with synthetic meshes. These findings do not support the routine use of biological meshes in laparoendoscopic inguinal hernia repair. German Clinical Trials Register Identifier: DRKS00010178.
To compare surgical outcomes, postoperative recovery, and sexual function between transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and transumbilical laparoendoscopic single-site surgery (TU-LESS) for salpingectomy in patients with tubal ectopic pregnancy. Single-blind randomized controlled trial. University-affiliated tertiary care center specializing in women's and children's health. Seventy-two patients with tubal ectopic pregnancy, eligible for laparoendoscopic salpingectomy, were enrolled between January 19 and September 30, 2024. Patients were randomly assigned in a 1:1 ratio to undergo vNOTES or TU-LESS salpingectomy. vNOTES or TU-LESS salpingectomy, with perioperative assessment and 3 to 6 months of postoperative follow-up. Except for the incisional wound assessor, outcome evaluators were blinded to group allocation. The primary outcome, intraoperative conversion rate, was 0 in both groups. Baseline demographic and clinical characteristics were comparable between groups. Compared with TU-LESS, vNOTES was associated with significantly lower pain scores at 12, 24, and 48 hours (all p <.001), shorter operative time (44.89 ± 10.30 vs 50.44 ± 10.31 minutes, p = .025), and reduced postoperative analgesic use (2.8% vs 22.2%, p = .013). No significant differences were observed in intraoperative blood loss, complications, length of hospital stay, or incidence of incisional hernia. Female Sexual Function Index (FSFI) scores remained comparable between groups before and after surgery (p >.05). vNOTES and TU-LESS salpingectomy showed similarly low conversion rates; although the trial was not powered for secondary outcomes, vNOTES deomonstrated better postoperative pain control and cosmetic satisfaction, with postoperative sexual function remaining comparable between approaches. ChiCTR2400082909, registered on April 10, 2024 (https://www.chictr.org.cn/showprojEN.html?proj=224201).
BACKGROUND: Radical resection of giant choledochal cysts (diameter ≥ 10 cm) in infants presents technical challenges, particularly when attempted with minimally invasive approaches. The primary difficulty lies in the cyst’s mass effect in the limited abdominal space. Although transumbilical laparoendoscopic single-site surgery (LESS) offers potential cosmetic and minimally invasive advantages, evidence regarding its feasibility and safety for managing these giant cysts remains limited. METHODS: This single-center, retrospective study with a historical control group included infants who underwent radical excision for giant choledochal cysts between June 2016 and December 2024. The final follow-up date for the full cohort was September 30, 2025. All patients were assigned to either the LESS group (n = 9) or the open surgery cohort (n = 18), which served as the historical control. During transumbilical LESS, we relied on cyst decompression and a novel “relay suspension technique”. This combination effectively facilitated intraoperative exposure. Perioperative and follow-up outcomes were compared between the two groups. RESULTS: The two groups were comparable in baseline characteristics. Operative time was longer in the LESS group (median 3.4 h vs. 2.5 h; p = 0.006). However, patients benefited from reduced intraoperative blood loss (median 10.0 ml vs. 20.0 ml; p < 0.001), shorter postoperative fasting time (median 2.0 days vs. 3.0 days; p = 0.011), and shorter duration of abdominal drainage (median 0.0 days vs. 4.0 days; p = 0.001). The two groups demonstrated comparable postoperative hospital stays and complication rates. All LESS procedures were completed without conversion to open surgery. At a median follow-up of 33 months, no late complications occurred in the LESS group, and cosmetic outcomes were favorable. CONCLUSIONS: In this preliminary single-center retrospective study, the transumbilical LESS approach was supplemented by cyst decompression and a “relay suspension technique.” For specific infants with giant choledochal cysts, this approach appears to be a feasible and safe minimally invasive option. But this conclusion is based on procedures performed by experienced teams at specialized centers. This approach offers potential advantages in blood loss and early recovery. At a median follow-up of 33 months, cosmetic and long-term outcomes are favorable. While these findings are encouraging, they should be considered preliminary pending validation in larger, prospective studies.
Laparoscopic surgery has become the gold standard for the surgical management of benign gynecologic pathologies. Our objective was to assess the current evidence regarding the safety and efficacy of laparoendoscopic single-site surgery (LESS) in the treatment of benign adnexal diseases. We comprehensively searched PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and ClinicalTrials.gov from inception to 18 October 2025. We included randomized controlled trials (RCTs) comparing LESS with conventional laparoscopy (CL) for the treatment of benign adnexal diseases. Primary outcomes were the perioperative complication rate, postoperative pain, and cosmetic satisfaction. Secondary outcomes included operative time, estimated blood loss during surgery, hemoglobin drop, conversion to laparotomy, and length of hospital stay after surgery. All analyses were performed using random effects or fixed effects models. Clinical heterogeneity was explored using subgroup and sensitivity analyses. We included eight articles reporting results from RCTs comparing LESS and CL in the final analysis. There were no significant differences between LESS and CL in terms of the perioperative complication rate (risk ratio (RR), 2.88; 95% confidence interval (CI), 0.70 to 11.78; p = 0.14) and postoperative pain scores at 6 h (weighted mean difference (WMD), -0.31; 95% CI, -0.75 to 0.13; p = 0.16), 24 h (WMD, -0.23; 95% CI, -0.46 to 0.00; p = 0.05), and 48 h (WMD, -0.24; 95% CI, -0.77 to 0.30; p = 0.39). There were also no differences in terms of operative time (WMD, 3.68; 95% CI, -0.81 to 8.17; p = 0.11), hospital stay after surgery (WMD, -0.13; 95% CI, -0.29 to 0.03; p = 0.11), estimated blood loss during surgery (WMD, -7.63; 95% CI, -31.83 to 16.57; p = 0.54), and hemoglobin drop (WMD, 0.18; 95% CI, -0.02 to 0.39; p = 0.08). This systematic review and meta-analysis provides evidence that LESS appears effective and safe for the treatment of benign adnexal diseases, as it is generally equivalent to CL in terms of perioperative outcomes. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024608657, Identifier: CRD42024608657.
Laparoendoscopic single-site donor nephrectomy (LESS-DN) has been proposed as a minimally invasive alternative to conventional laparoscopic donor nephrectomy (CLDN), but its perioperative advantages remain controversial. This meta-analysis aimed to compare the outcomes of LESS-DN and CLDN based on randomized controlled trials (RCTs). PubMed, Embase, and the Cochrane Library were searched up to August 20, 2025, for English-language RCTs comparing LESS-DN and CLDN. The risk of bias was assessed using the original Cochrane Risk of Bias tool (RoB 1.0), and pooled analyses were performed using Review Manager 5.4.1 software. Four randomized controlled trials involving 274 donors (LESS-DN, n = 136; CLDN, n = 138) were included. There were no significant differences between groups in operative time, warm ischemia time, estimated blood loss, length of hospital stay, time to extraction, or overall complication rates. Based on the currently available randomized evidence, no statistically significant differences were detected between LESS-DN and CLDN in the perioperative outcomes analyzed in living kidney donors. Further adequately powered, multicenter randomized trials-particularly evaluating postoperative pain, patient-reported recovery, and cosmetic satisfaction-are warranted.
Ovarian mature teratoma (OMT) is a common benign gynecological tumor, with surgical resection being the primary treatment. Laparoendoscopic single-site surgery (LESS) has been widely used in various surgical procedures due to its advantages of minimal invasiveness and faster recovery. However, there is limited research on LESS for OMT in adolescents. This study aims to evaluate the safety and efficacy of LESS in children and adolescents aged 18 years or younger. Patients who underwent LESS cystectomy or laparotomic cystectomy in West China Second Hospital, Sichuan University, from 01/01/2019 to 31/12/2023, were enrolled in this retrospective cohort study. They were divided into LESS group and open surgery group based on the surgical approaches. We collected surgical conditions, postoperative conditions and complications to evaluate the safety and efficacy. Patients were followed up one month and one year after surgery by phone-call and recurrence was recorded. A t-test or chi-square test was performed according to the data type characteristics. We included 169 pediatric and adolescent girls (151 LESS cases and 18 open cases) in this study. The average age, body mass index, and menstrual history were not statistically different (P=0.84, 0.93, 0.93, retrospectively). Compared with open group, the tumors in LESS group were smaller and the difference was statistically significant (6.5±0.2 vs. 18.9±1.0 cm, P<0.001). The surgical outcomes and recovery in LESS group were better and difference was statistically significant (surgical duration, P<0.001; estimated blood loss, P=0.02; complications, P<0.001; exhaust time, P<0.001; hospital stays, P<0.001). LESS is a safe and effective method for female children and adolescents with OMT. A tumor diameter <15 cm may serve as one of the factors favoring LESS, but the final surgical approach should be determined through comprehensive consideration of tumor characteristics, the patient's general condition, and fertility requirements.
To determine the clinical effect of transumbilical laparoendoscopic single-site surgery (TU-LESS) combined with extracorporeal operation mode in the treatment of noncancerous ovarian cysts. Observational study. Place and Duration of the Study: Department of Gynaecology, Maternity and Child Health Centre of Qinhuangdao, Qinhuangdao, China, from December 2022 to September 2024. A total of sixty patients undergoing cystectomy were subjected to either the TU-LESS with extracorporeal technique (n = 30) or the multi-port laparoscopic surgery (MPLS) (n = 30). Surgical parameters, inflammatory markers (SAA, CRP, and IL-6), recovery indices, and satisfaction were retrospectively compared using t-test or χ² test. No significant differences were found in operative duration, blood loss, and complications (p >0.05). The observation group had an earlier postoperative anal exhaust time, a shorter hospital stay, and a reduced incision pain score 24 hours after surgery compared to the comparison group (p <0.05). Inflammatory cytokine concentrations were decreased in the observation group compared to the comparison group (p <0.05). Patient satisfaction regarding surgical incisions was significantly higher in the observation group than in the comparison group (p <0.05). Compared to the conventional MPLS, TU-LESS with extracorporeal cystectomy accelerates recovery, reduces inflammation, and improves patient satisfaction. Transumbilical laparoendoscopic single-site surgery, Multi-port laparoscopic surgery, Non-cancerous ovarian cyst, Perioperative outcome.
Laparoscopic and endoscopic cooperative surgery (LECS) is a hybrid minimally invasive technique originally developed for treatment of gastric submucosal tumors. Several modifications of LECS-including inverted LECS, non-exposed endoscopic wall-inversion surgery, and closed LECS have evolved over a period of time to address the earlier concerns about peritoneal contamination and tumor seeding. These innovations have led to the application of combined laparoendoscopic techniques to several gastrointestinal (GI) lesions such as the duodenum, colon, and rectum. This minireview explores the evolution, current applications, and future potential of laparoendoscopic surgery in GI diseases.
To evaluate the impact of neuromuscular blockade (NMB) depth on surgical conditions and postoperative outcomes in patients undergoing laparoendoscopic single-site (LESS) surgery for total hysterectomy. A total of 243 female patients scheduled for LESS surgery for total hysterectomy under intravenous anesthesia were randomly allocated to two groups: the deep NMB group (1–2 post-tetanic count) and the moderate NMB group (1–2 train-of-four response) with continuous intravenous infusion of cisatracurium. The primary endpoint was the Surgical Rating Scale (SRS) score during the surgery. Secondary endpoints included additional NMB requirements during surgery, and postoperative outcomes including Visual Analog Scale (VAS) scores, incidence of shoulder pain, morphine consumption, and the incidence of nausea and vomiting. Mean (standard deviation) SRS was 4.31 (0.86) during moderate NMB and 4.75 (0.54) during deep NMB (P < 0.001). Moderate NMB resulted in 16.26% of scores at the lower end of the scale (scores 1–3), whereas deep NMB achieved 90.83% of scores at the higher end (scores 4–5). The deep NMB group demonstrated decreased postoperative shoulder pain (P < 0.001) with lower VAS scores at 6/24/48 hours (P < 0.001), and reduced morphine consumption 72 h post-hysterectomy (P < 0.001). However, the time from agent withdrawal to train-of-four (TOF) ratio 25%, to TOF ratio 90%, and to extubation was significantly prolonged in the deep NMB group (P < 0.001). No significant differences were observed between groups regarding recovery index, length of stay in the post-anesthesia care unit (PACU), blood gas analysis, or postoperative complications, including postoperative nausea and vomiting (PONV) and pulmonary infection (P > 0.05). Deep NMB significantly improves surgical conditions during LESS hysterectomy while reducing postoperative pain. The online version contains supplementary material available at 10.1186/s13741-026-00664-7.
Chronic postoperative inguinal pain (CPIP) is a major adverse outcome of groin hernioplasty. Despite multiple CPIP studies, investigations involving unselected patients and sufficiently large cohorts to assess multiple predictors concurrently are still needed. This study evaluated the relative impact of preoperative predictors of CPIP after laparoendoscopic groin hernia repair. A secondary aim was to assess selection bias. This population-based cohort study included unilateral laparoendoscopic repairs from a prospective CPIP project within the Swedish Hernia Registry, where all groin hernia repairs recorded between September 2012 and December 2018 were surveyed at 1 year postoperatively. Responses were analyzed using multivariable logistic regression to assess whether any of 15 predetermined preoperative candidate variables, including demographics, comorbidities, and hernia-related factors, were associated with CPIP. Among 15 360 eligible patients, 10 525 (69%) responded, of whom 3 027 (29%) reported CPIP. Seven preoperative factors significantly associated with CPIP: • female sex (adjusted odds ratio [AOR] 1.15, 95% CI 1.03-1.28) • younger age (< 45 vs. ≥ 65 years: AOR 1.36, 95% CI 1.25-1.49) • BMI > 25 kg/m² (AOR 1.38, 95% CI 1.26-1.51) • ASA grade > 1 (AOR 1.23, 95% CI 1.12-1.36) • recurrent hernia (AOR 1.33, 95% CI 1.19-1.49) • femoral hernia (vs. medial and/or lateral; AOR 1.20, 95% CI 1.002-1.43) • small defects (AOR 1.18, 95% CI 1.06-1.30) Response rates varied significantly across most variables, particularly age; non-respondents were on average 7 years younger, suggesting selection bias. The 7 identified preoperative predictors should be considered when designing and interpreting CPIP studies. Selection bias was present, but likely less pronounced than in previous CPIP surveys. Future research should incorporate preoperative pain assessment, improve response rates among younger patients, and conduct robust non-respondent analyses.
The surgical smoke generated in laparoendoscopic surgery compromises visual clarity and poses health hazards to the operating team. While numerous strategies to maintain a clear surgical field and mitigate these risks have been developed, existing research remains fragmented. This lack of systematic evidence of effective solutions creates challenges in clinical practice. We conducted this study to evaluate the effectiveness of current smoke evacuation methods aimed at maintaining surgical field visibility and mitigating occupational hazards during laparoendoscopic procedures. The analysis synthesizes literature retrieved from PubMed/MEDLINE, Scopus, and the Cochrane Library databases, with all included studies published up until January, 2025. A total of 19 techniques were categorized systematically into four distinct approaches: active instrument-tip suction, port-side evacuation, valveless trocar systems, and continuous suction for gasless laparoendoscopy. Each category exhibits unique operational mechanisms, advantages, and limitations. Multiple solutions exist for surgical smoke management in laparoendoscopic procedures, but their future development should prioritize creating more efficient, user-friendly, and safer evacuation technologies that will account for global healthcare resource disparities to ensure broad clinical applicability.
Background/Objectives: To systematically compare the effectiveness and safety of laparoendoscopic single-site surgery (LESS) versus conventional multi-port laparoscopic surgery (CLS) for ovarian cystectomy in women with benign ovarian cysts, focusing on operative outcomes, postoperative pain, and recovery parameters. Methods: A comprehensive search was conducted in PubMed, Cochrane Library, Web of Science, ClinicalTrials.gov, and SCOPUS from inception to 1 June 2024. Randomized controlled trials and observational studies directly comparing LESS with CLS for benign ovarian cystectomy (excluding adnexectomy) were included. Primary outcomes were operative time, blood loss, hospital stay, postoperative pain, and complications. Data were pooled using mean differences (MD) or risk ratios with 95% confidence intervals in fixed- or random-effects models according to heterogeneity. Results: Nine studies (1 randomized trial, 8 observational; total n = 1368 patients: 702 LESS, 666 CLS) were included. LESS was associated with longer operative time (MD 9.42 min, 95% CI 3.47-15.37, p = 0.002) but shorter hospital stay (MD -0.26 days, 95% CI -0.39 to -0.14, p < 0.001). No significant differences were found in blood loss, postoperative analgesic requirements, hemoglobin drop, or complication rates. Postoperative pain scores at 6 and 24 h were similar, although adjusted analysis suggested marginally lower pain at 24 h with LESS (MD -0.20, p = 0.05). Conclusions: Laparoendoscopic single-site ovarian cystectomy is a safe and reliable alternative to conventional multi-port laparoscopy, offering the advantage of shorter hospital stay despite slightly longer operative time, with equivalent safety profile and postoperative pain. LESS expands minimally invasive options in benign gynecologic surgery 1.1 s.
To evaluate the feasibility and safety of laparoendoscopic single-site robot-assisted nephroureterectomy (LESS-RANU) by comparing perioperative, pathological, and oncological results with the conventional multiport laparoendoscopic approach in the retroperitoneal approach for the management of urinary tract urothelial carcinoma. Between January 2021 and October 2024, our center treated 56 patients with urinary tract urothelial carcinoma using either the LESS-RANU (n=31) or the conventional multi-port laparoscopic nephroureterectomy (LNU) (n=25) via the retroperitoneal approach. Data including demographic, perioperative, pathological, and oncological characteristics were collected. No significant differences were found in patient demographics and tumor characteristics between the two groups. No serious intraoperative complications occurred in both groups. The mean operation time, skin incision length, Visual Analog Scale pain scores, time for repositioning and follow-up duration for the LESS-RANU group and the LNU group were 138.23 min and 180.40 min, 6.48 cm and 15.40 cm, 3.23 and 4.60, 5.71 min and 30.24 min, and 10.84 months and 22.88 months, respectively (p<0.001). There were no significant differences in other perioperative data between the two groups. Multiple linear regression identified an association of body mass index with operation time in the LESS-RANU group (p<0.001). The mean operative time of the subsequent 15 patients was significantly lower than that of the initial 16 patients (130.33 min vs. 145.31 min, p=0.044). There were no significant differences in the pathological characteristics between the two groups. Recurrences developed in four patients: one in the LESS-RANU group and three in the LNU group. LESS-RANU is safe and more effective compared to LNU via the retroperitoneal approach, especially for patients with low body mass index.
To explore the clinical efficacy of transumbilical laparoendoscopic single-site extracorporeal surgery (TU-LESS-E) in the treatment of giant ovarian cysts and huge cystic pelvic masses. This was a retrospective study. Sixty patients diagnosed with giant ovarian cysts and huge cystic pelvic masses undergoing laparoscopic ovarian cystectomy in Maternity & Child Care Center of Qinhuangdao from May 2022 to October 2024 were selected, and randomly divided into observation group and control group (n=30 each group). The control group was given conventional multiport laparoscopy, while the observation group was treated with TU-LESS-E cystectomy. Perioperative outcomes such as surgical duration, intraoperative blood loss and incidence of cystic fluid overflow, pain intensity six hours and 24 hours, one months and three months after surgery were compared between the two groups. No significant differences were found in intraoperative blood loss or surgical duration between the two groups (p> 0.05). The incidence of cystic fluid overflow in the observation group was significantly lower than that in the control group (p< 0.05). The VAS score for incisional pain in the observation group was significantly lower than that in the control Group-6 and 24 hours after surgery (p< 0.05). The incidences of postoperative complications showed no significant differences between the two groups (p> 0.05). TU-LESS-E presents good results in the treatment of giant ovarian cysts and huge cystic pelvic masses. It can reduce surgical traumas and pain, the occurrence of cystic fluid overflow, as well as impact on ovarian reserve.
Controversies and challenges over minimally invasive approach in performing radical hysterectomy for early-stage cervical cancer have been raised. This study aimed to determine whether robotic approach was superior to traditional single-site radical hysterectomy with no-manipulation technique for early-stage cervical cancer. Patients diagnosed with FIGO 2018 stage IB1, IB2 or IIA1 cervical cancer who underwent robotic or traditional single-site radical hysterectomy and pelvic lymphadenectomy between April 2019 and December 2023 were enrolled to assess the perioperative and survival outcomes. 73 patients were included in the robotic group and 51 cases in the traditional group. The robotic group had significantly shorter operative time (236.5 ± 52.8 vs 390.8 ± 73.5 min, p<0.001), less blood loss (50.0 vs 150.0 mL, p<0.001), and shorter drainage time (3.7 ± 1.2 vs 4.7 ± 1.9 days, p=0.001), with a tendency of less conversions and complications compared to the traditional group. The two groups exhibited comparable 3-year disease-free survival (89.8% vs 95.8%, p=0.399) and overall survival (95.8% vs 96.3%, p=0.752) rates. Robotic and traditional single-site radical hysterectomies with no-manipulation techniques are both feasible and safe for early-stage cervical cancer with comparable survival outcomes, though longer follow-up is needed to confirm non-inferiority. The robotic system could significantly reduce surgical difficulties and improve perioperative outcomes.
To evaluate the feasibility and effectiveness of robot-assisted laparoendoscopic single-port surgery (R-LESS) in infant urology and to report our early single-center experience. Clinical data were retrospectively collected from 20 infants (≤ 12 months) who underwent R-LESS using the Da Vinci Xi system between February 2024 and April 2025. Information included demographic characteristics, perioperative parameters, and postoperative outcomes. The median age at surgery was 2.5 (IQR: 2, 4) months. Sixteen patients underwent pyeloplasty, two underwent ureteral reimplantation, and two underwent nephrectomy. All procedures were completed successfully without conversion to open surgery or intraoperative complications. The median docking time, console time, and total operative time were 7 (IQR: 6, 8) min, 181 (IQR: 156, 207) min, and 212 (IQR: 189, 238) min, respectively. Median estimated blood loss was 5 (IQR: 5, 9) mL. Median total hospital stay was 6 (IQR: 6, 10) days, with a median postoperative stay of 2 (IQR: 1, 4) days. The median follow-up duration was 9.1 (IQR: 5.4, 11.2) months. Postoperative complications were observed in three cases (15%): two patients (10%) developed febrile urinary tract infections (Clavien-Dindo Grade II), which resolved with antibiotic treatment; one patient (5%) required hospital readmission for wound debridement due to poor healing (Clavien-Dindo Grade III), with favorable postoperative recovery. R-LESS is a safe and effective minimally invasive surgical approach in infant urology.
The main characteristics of the robotic surgical system include high-definition three-dimensional imaging, flexible and stable instruments, and an ergonomic console design. Incorporating robotic systems with laparoendoscopic single-site surgery (LESS) represents a promising concept to restore the operational triangulation, enhance surgical dexterity and precision, and reduce surgeons' fatigue, thereby improving surgical safety and efficacy. The objective of this study was to prove the feasibility, safety and efficacy of robotic LESS (R-LESS) using the da Vinci Xi surgical system in gynecology. This was a retrospective study conducted at a tertiary hospital. We reviewed and descriptively analyzed patients' demographics and perioperative outcomes of all benign and malignant R-LESS procedures performed at West China Second University Hospital between April 28, 2021 and September 30, 2023. A total of 721 patients underwent R-LESS during the study period. In the 400 benign cases, the median operative time was 145.0 (115.0, 180.8) minutes with 45.0 (20.0, 60.0) mL blood loss. Two cases (0.5%) required an additional port, and 1 (0.3%) converted to laparotomy. The intraoperative complication rate was 1.0%. These patients were discharged at a median length of 4.0 (3.0, 5.0) days postoperatively, and the mean pain score at 24 h after surgery was 2.0 ± 0.8. The postoperative complication rate within 3 months was 2.3%. In the 321 malignant cases, the median operative time was 218.0 (170.0, 282.0) minutes with blood loss of 50.0 (50.0, 100.0) mL. The intraoperative complication and conversion rates were 2.8% and 1.9%, respectively.The median hospital stay was 5.0 (4.0, 6.0) days and the pain assessment at 24 h postoperatively was 2.0 ± 0.7. The postoperative complication rate within 3 months was 13.1%. R-LESS using the da Vinci Xi system is feasible and safe in performing various gynecologic procedures, especially complex cases, where the surgical challenges of LESS are significantly mitigated with robotic assistance. Not applicable.
Vaginal natural orifice transluminal endoscopic surgery (vNOTES) and laparoendoscopic single-site surgery (LESS) are minimally invasive approaches for ovarian cystectomy, yet their comparative safety, efficacy, and patient-centered outcomes remain insufficiently evaluated, necessitating this systematic review and meta-analysis. In December 2024, we conducted a systematic search using PubMed, Ovid Medline, and Ovid Cochrane. The Methodological Index for Non-Randomized Studies (MINORS) and the Revised Cochrane Risk of Bias (RoB 2) tools have been used for the risk of bias assessment. From an initial 588 records, four studies (576 patients: 197 vNOTES, 379 LESS) were included. Meta-analysis revealed that vNOTES significantly reduced operative time (pooled mean difference (MD) -13.62 min, P = 0.02) and hospital stay (MD -0.44 days, P = 0.03) compared to LESS, with sensitivity analyses strengthening these findings (e.g., MD -18.23 min and -0.63 days post-exclusion). Postoperative pain scores (by visual analogue score (VAS)) were markedly lower for vNOTES (MD -1.09, P < 0.00001), and time to flatus recovery was shorter (MD -3.72 h, P < 0.00001). No significant differences were observed in intraoperative blood loss (MD -6.99 mL, P = 0.27), conversion rates (odds ratio (OR) 1.15, P = 0.91), or overall adverse events (OR 0.70, P = 0.41), though heterogeneity persisted in retrospective subgroup analyses (I² = 72-96 % for operative time, and pain scores). These findings position vNOTES as a favorable option for ovarian cystectomy, offering improved efficacy with safety comparable to LESS; however, further RCTs are needed to strengthen these conclusions.
To evaluate the efficacy and safety of transumbilical laparoendoscopic single site surgery (TU-LESS) in treating mid-pregnancy ovarian cyst torsion. We conducted a retrospective analysis of the clinical data of 54 mid-pregnancy patients who underwent open surgery for ovarian cyst torsion repositioning and cystectomy, and 31 patients who underwent TU-LESS at Qinghai Red Cross Hospital between January 2020 and January 2025. Key parameters analyzed included operative time, intraoperative blood loss, postoperative complications, hospital stay, postoperative first flatus time, preoperative and postoperative fetal heart rates, pregnancy outcomes, and postoperative visual analog scale (VAS) pain scores. There were no significant differences between the two groups in terms of baseline characteristics such as age, BMI, tumor diameter, number of deliveries, history of pelvic surgery, pregnancy duration, duration of abdominal pain, or preoperative fetal heart rate. The TU-LESS group had significantly shorter operative times compared to the laparotomy group. No significant differences were observed in tumor pathology, intraoperative blood loss, or number of tumor ruptures. The TU-LESS group experienced shorter hospital stays, fewer postoperative complications, and lower VAS scores at 48 h post-operation compared to the laparotomy group. However, there were no significant differences between the groups in terms of time to first flatus, postoperative fetal heart rates, and VAS scores at 24 h post-operation. TU-LESS is a safe and feasible surgical method for treating mid-pregnancy ovarian cyst torsion and plays an important role in protecting maternal and fetal safety.