An Innovative Practice of Single-port Endoscopic Surgery: Abdominal Wall Endometrioma Resection Through the Scar

A 37-year-old woman was diagnosed with abdominal wall endometrioma in 2020. She underwent cesarean delivery in 2013 and had stabbing pain in her right lower abdomen during menstruation since 2016. The endometrioma, with a 1.6-cm × 2.3-cm × 7.0-cm mass in the right rectus abdominis muscle (Fig. 1), was separate from the original scar of the cesarean delivery (Fig. 2).Fig. 2Endometrioma. The endometrioma was extensive and separate from the original scar of the cesarean delivery (2020).View Large Image Figure ViewerDownload Hi-res image Download (PPT) For an aesthetic incision and better postoperative recovery, single-port endoscopic surgery (SPES) was performed on the abdominal scar. First, a 3-cm long incision was made at the old scar where the lower edge of the mass was located, and part of the lesion under the scar was excised to create space for SPES. Furthermore, the skin protector was placed in the incision, and a simple port platform was made using gloves (Fig. 3), through which the space was insufflated with carbon dioxide. Moreover, the lesion was removed, and the abdominal wall fascia was repaired with a patch via SPES. A negative pressure drainage bottle was placed to promote healing. The pathologic results confirmed endometriosis. Compared with traditional open or multiport endoscopic surgery, SPES may have the advantages of less trauma, faster postoperative recovery, and more aesthetic scars [1Fahmy O Fahmy UA Alhakamy NA Khairul-Asri MG. Single-port versus multiple-port robot-assisted radical prostatectomy: a systematic review and meta-analysis.J Clin Med. 2021; 10: 5723Crossref PubMed Scopus (6) Google Scholar, 2de Groof EJ Buskens CJ Bemelman WA. Single-port surgery in inflammatory bowel disease: a review of current evidence.World J Surg. 2016; 40: 2276-2282Crossref PubMed Scopus (12) Google Scholar, 3Casaccia M Fornaro R Papadia FS et al.Single-port vs. conventional multi-port laparoscopic lymph node Biopsy.JSLS. 2020; 24 (e2020.00045)Crossref PubMed Scopus (1) Google Scholar, 4Ganesan V Steinberg RL Garbens A et al.Single-port robotic-assisted simple prostatectomy is associated with decreased post-operative narcotic use in a propensity score matched analysis.J Robot Surg. 2021 Apr 10; ([Epub ahead of print])PubMed Google Scholar]. Restricted by operating space requirements, SPES is mainly used in natural cavities, such as the thoracic and abdominal cavities. Furthermore, SPES has been successfully used in breast and thyroid diseases through liposuction and suspension to create space [5von Ahnen T Wirth U von Ahnen M et al.Endoscopic cephalic access thyroid surgery (EndoCATS) using the retroauricular approach - a single centre retrospective data analysis.Surg Endosc. 2022; 36: 117-125Crossref PubMed Scopus (4) Google Scholar, 6Blay Aulina L Cremades Pérez M Navinés Lopez J et al.Pneumoendoscopic single port approach to breast cancer. How we do it?.Surg Oncol. 2020; 32: 41-45Crossref PubMed Scopus (2) Google Scholar, 7Lai HW Lin SL Chen ST et al.Single-axillary-incision endoscopic-assisted hybrid technique for nipple-sparing mastectomy: technique, preliminary results, and patient-reported cosmetic outcome from preliminary 50 procedures.Ann Surg Oncol. 2018; 25: 1340-1349Crossref PubMed Scopus (32) Google Scholar]. In this case, the lesion was extensive and separate from the original scar. If open surgery was performed, a new large scar would be formed. With the SPES technique, the incision was not only small but also located within the original incision. Furthermore, miniaturization of the incision reduced postoperative pain, which is conducive to the rapid recovery of patients after surgery. Download .jpg (.26 MB) Help with files Download .jpg (.38 MB) Help with files