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Low-cost total laparoscopic hysterectomy by single-incision laparoscopic surgery using only reusable standard laparoscopic instruments
AbstractThe purpose of this study was to demonstrate the feasibility and safety of total laparoscopic hysterectomy (TLH) by single-incision laparoscopic surgery (SILS) with
conventional, reusable laparoscopic instruments, inserted through an inexpensive, self-constructed single-port device. Between June 2013 and April 2014, 15 TLHs by SILS were
performed by a single surgeon (BJ). Only conventional, reus-able laparoscopicinstruments were used. The self-constructed single-port devicewas made by assembling a surgical glove, a wound protector, one reusable 10-mm trocar, and four reus-able 5-mm trocars. The vaginal cuff was closed by intracorporeal suturing. Patient and perioperative data were analysed. Fifteen patients underwent TLH by SILS, and no conversion to standard laparoscopy or laparotomy was neces-sary. Mean operation time was 97 min (55–135 min), and mean drop in haemoglobin level was 1.2 g/dl (0–2.4 g/dl). There were no operative complications. Postoperative painscores were low. The mean weight of the removed uterus
was 118 g (50–208 g). TLH by SILS is feasible even when performed with reusable, conventional laparoscopic in-struments. An inexpensive, self-constructed single-port
device allows every surgeon worldwide to accomplish single-incision surgery without the need to invest inexpensive ports, disposable instruments, sealing devices, or auto-locking sutures.
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