Adnexal Masses Treated Using a Combination of the SILS Port and Noncurved Straight Laparoscopic Instruments: Turkish Experience and Review of the Literature

Objective. To report our experience treating adnexal masses using a combination of the SILS port and straight nonroticulating laparoscopic instruments. Study Design. This prospective feasibility study included 14 women with symptomatic and persistent adnexal masses. Removal of adnexal masses via single-incision laparoscopic surgery using a combination of the SILS port and straight nonroticulating laparoscopic instruments was performed. Results. All of the patients had symptomatic complex adnexal masses. Mean age of the patients was 38.4 years (range: 21–61 years) and mean duration of surgery was 71？min (range: 45–130？min). All surgeries were performed using nonroticulating straight laparoscopic instruments. Mean tumor diameter was 6？cm (range: 5–12？cm). All patient pathology reports were benign. None of the patients converted to laparotomy. All the patients were discharged on postoperative d1. Postoperatively, all the patients were satisfied with their incision and cosmetic results. Conclusion. All 14 patients were successfully treated using standard, straight nonroticulating laparoscopic instruments via the SILS port. This procedure can reduce the cost of treatment, which may eventually lead to more widespread use of the SILS port approach. Furthermore, concomitant surgical procedures are possible using this approach. However, properly designed comparative studies with single port and classic laparoscopic surgery are urgently needed. 1. Introduction Adnexal masses are one of the most common indications for surgery in gynecology clinics, and laparoscopy is generally accepted as the gold standard treatment. Classical laparoscopic surgery for adnexal masses is generally performed using ≥3 trocars. On the other hand, single-port access surgery (SPAS), also known as laparoendoscopic single-site surgery (LESS) and single-incision laparoscopic surgery (SILS), is an evolving endoscopic approach for minimal access surgery. Various surgical procedures, including appendectomy, cholecystectomy, nephrectomy, oophorectomy, hysterectomy, adrenalectomy, gastric bypass, Nissen fundoplication, hernia repair, splenectomy, and colon resection, have been performed via SILS. SILS can result in better cosmesis, shorter recovery time, and less pain than conventional laparoscopy, which requires use of multiple trocar incisions [1, 2]. It was recently reported that adnexal masses could also be treated via SILS [3, 4]. Endoscopic surgery conducted via 3 special luminal ports, including the SILS port (Covidien, Norwalk, CT), GelPort (Applied Medical Resources, Rancho Santa