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Single-Incision Laparoscopy in Gynecologic Surgery: A Systematic Review and Meta-analysis

Murji, Ally MD; Patel, Virendra I. MD, MPH; Leyland, Nicholas MD, MHCM; Choi, Matthew MD

doi: 10.1097/AOG.0b013e318288828c

OBJECTIVE: To evaluate surgical outcomes for gynecologic surgery performed by single-incision laparoscopy compared with conventional multi-incision laparoscopy.

DATA SOURCES: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and through August 2012. We also screened reference lists of retrieved articles and manually searched abstracts from conference proceedings.

METHODS OF STUDY SELECTION: We included randomized control trials (RCTs) and high-quality observational studies that compared outcomes for single-incision laparoscopy and conventional laparoscopy for gynecologic surgery in patients. Included studies met predefined quality criteria and reported, at minimum, on complications, conversions, and operative time.

TABULATION, INTEGRATION, RESULTS: Six RCTs and 15 observational studies met inclusion criteria, with a total of 2,085 patients (899 single-incision laparoscopies and 1,186 conventional laparoscopies). In the pooled analysis, there was no significant difference in the risk of total complications between single-incision laparoscopy and conventional laparoscopy groups (relative risk 1.01, 95% confidence interval [CI] 0.72–1.40; P=.97, random effects model). The meta-analysis was powered to detect a 5% difference in complications (power=0.8, alpha=0.05). Mean operative time for adnexal surgery performed by single-incision laparoscopy was 6.97 minutes longer than conventional laparoscopy (95% CI 0.16–13.77; P=.045; I 2=47.2; random effects based on three RCTs). There was no significant difference in mean operative time for hysterectomy procedures performed by single-incision laparoscopy (8.29 minutes, 95% CI −5.85 to 22.43; P=.251; I 2=83.6; random effects based on three RCTs). Clinical outcomes of postoperative pain, change in hemoglobin, length of hospital stay, and scar cosmesis could not be pooled because of paucity of data and lack of uniform reporting.

CONCLUSION: There was no difference in the risk of complications between single-incision laparoscopy and conventional laparoscopy approaches in gynecologic surgery. Studies with imprecise effect sizes suggest that single-incision laparoscopy may have longer operative time for adnexal surgery, but not for hysterectomy. Effects on other surgical outcomes remain uncertain.

Single-incision laparoscopy is comparable with conventional multi-incision laparoscopy with respect to risk of complications but may take slightly longer to perform.Supplemental Digital Content is Available in the Text.

Departments of Obstetrics and Gynecology and Surgery, McMaster University, Hamilton, Ontario, Canada; and the Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.

Corresponding author: Ally Murji, MD, Hamilton Health Sciences, 1280 Main Street West HSC 2F39, Hamilton, Ontario L8S 4K1 Canada; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Michael A. Stoto, PhD, Adjunct Professor of Biostatistics, Harvard School of Public Health, for his guidance, critical review, and editorial assistance.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.