Laparoendoscopic single site surgery for severe pelvic adhesion release and total hysterectomy with bilateral salpingectomy

Hysterectomy is a frequent gynecological surgical technique. The surgical approaches are laparotomic, virginally, and laparoscopic. The advantages of laparoscopic surgery are smaller surgical wounds, less pain, shorter hospital stay, and fewer complications. Laparoendoscopic single-site surgery (LESS), is a new type of laparoscopic surgery, which is performed through a 2-3 cm incision in the umbilicus, and the laparoscope and instruments are inserted to complete the operation. However, in LESS, the "chopstick" effect increases the difficulty of the surgery. This video aims to describe a case for severe pelvic adhesion release and total hysterectomy with bilateral salpingectomy. A 49-year-old female patient diagnosed with adenomyosis and uterine fibroids underwent LESS total hysterectomy and bilateral salpingectomy. The procedure was performed with a laparoscope, standard laparoscopic instruments and uterine manipulator. After general anesthesia, a 3-cm port was then inserted through the umbilical incision. The surgery was completed by alternately using bipolar electrocoagulation, an ultrasound knife, and scissors through the single port. Divisions were made in bilateral utero-ovarian ligaments, tube pedicles and round ligaments. The vesicouterine peritoneal fold was dissected. Then, the posterior peritoneum and both uterosacral ligaments were dissected. With bipolar electrocautery and ultrasound knife, bilateral uterine vessels were dissected safely. The vagina wall was cut off with the monopolar electrocautery L-hook. The vaginal cuff was sutured laparoscopically, with 2-0 polydioxanone suture, with an 1/2 curved 36-mm needle. After hemostasis, we removed both the port and the laparoscope, and then closed the umbilical fascia and subcutaneous tissue. The uterus weight was 570 g, surgical duration was 146 minutes and estimated blood loss was 110 mL. The postoperative stay was 3 days. There was no morbidity. This LESS total hysterectomy and bilateral salpingectomy seems to be feasible and safe.