Comparison of Single-site and Three-port Hysterectomy for Benign Uterine Diseases: A Randomised Trial (LESS-H)

Objective: To evaluate the feasibility and safety of laparoendoscopic single-site (LESS) vaginal hysterectomy compared to conventional three-port laparoscopic-assisted vaginal hysterectomy (LAVH) for benign and pre-invasive uterine disease. Design: Randomised controlled trial. Setting: South Korea. Population Patients who were scheduled to undergo laparoscopic hysterectomy for the benign and pre-invasive uterine diseases Methods: Patients were randomised to LESS LAVH group and conventional three-port LAVH group. Main outcome Measures To compare the average length of postoperative hospital stay and the proportion of patients discharged within two days after surgery between the LESS and three-port groups. Results: A total of 428 patients were randomised to the LESS group (n=216) and the conventional group (n=212). The two groups did not show significant differences in the average length of postoperative hospital stay (LESS vs. three-port, 2.17 days vs. 2.15 days, P = 0.757) and the proportion of patients discharged within two days after surgery (LESS vs. three-port, 93% vs. 90%, P = 0.277). There were also no significant differences in operating time, hemoglobin change, and perioperative complications. While the visual analogue score (VAS) pain score during hospital stay was similar between the two groups, the pain score at the first outpatient visit was significantly lower in the LESS group (LESS vs. three-port, 3.29 vs. 3.93, P = 0.012). Conclusions: Although LESS LAVH was not superior to conventional multiport surgery, it is a feasible, safe procedure for managing benign and pre-invasive uterine diseases.