Single-Port vs Multiport Laparoscopic Hysterectomy: A Meta-Analysis of Randomized Controlled Trials

Abstract

Numerous studies have compared the surgical outcomes of single-port laparoscopic hysterectomy (LH) and conventional multiport LH, but the results are conflicting. The aim of this meta-analysis was to compare the safety and efficacy of single-port LH and multiport LH for benign gynecologic conditions based on published reports. PubMed, the Cochrane Central Register of Controlled Trials, and Embase were searched for relevant randomized controlled trials (RCTs). Outcome measures included intraoperative and postoperative complication rates, postoperative pain, conversion rate, operative time, estimated blood loss (EBL), and length of hospital stay. Pooled outcome measures (risk ratio [RR] and weighted mean difference [WMD]) were pooled with either a fixed-effects model or a random-effects model. Six RCTs encompassing 624 patients were included. There were no significant differences between single-port LH and multiport LH in terms of intraoperative complication rate (RR, 1.00; 95% confidence interval [CI], 0.14-7.05; p = .00), postoperative complication rate (RR, 0.95; 95% CI, 0.63-1.44; p = .82), postoperative pain (WMD, -0.42; 95% CI, -0.99 to 0.15; p = .15), conversion rate (p = .11), EBL (p = .51), or length of hospital stay (p = .27). However, single-port LH was associated with an average of 13.13 minutes longer operative time than multiport LH (p = .02). Our findings show that single-port LH is a safe and effective technique for benign gynecologic conditions, although it may require a longer operative time than multiport LH. Further large, prospective RCTs with long-term follow-up are needed to determine whether single-port LH really offers such benefits as better cosmetic outcome over multiport LH.

Keywords: Laparoscopic hysterectomy; Meta-analysis; Randomized controlled trial.