The postoperative course was uneventful in most patients, but three had a transient paralytic ileus, and five had pelvic hematoma, all of whom recovered www.selleckchem.com/products/z-vad-fmk.html following conservative managements. No port-related complications were noted, and the cosmetic results and patient satisfaction were excellent. 4. Conclusion SPA-LAVH is a technically safe and feasible procedure, and the homemade single-port system offers reliable and cost-effective access for single-port surgery. 5. Discussion As mentioned earlier, LAVH is most ideal for single-port surgery because the vagina of woman can be considered as an additional route for surgery; thus, uterine manipulators can be applied through the vagina. Unlike uterine repair after myomectomy, LAVH does not require a reconstruction process through a single port.

This is because the vaginal stump can be repaired not by laparoscopy, but through the vagina. Thus, SPA-LAVH is safe, and the procedure can be learned by skillful surgeons over a short period of time, because a considerable portion of the procedure can be performed through the vagina. The homemade three-channel, single-port system using a surgical glove and an Alexis wound retractor offers reliable, flexible, and cost-effective access for single-port procedures, and the system can be applicable in nonarticulated, rigid, conventional laparoscopic instruments [16, 17]. Limitations of single-port surgery include the loss of instrumental triangulation, reduced operative working space, reduced laparoscopic visualization, and instrumental crowding and clashing.

These limitations act as hurdles for some reconstructive procedures, such as repair after myomectomy. However, the reconstructive procedure can be performed with instrumental advancement, such as the use of articulated instruments [6�C15]. Our observations show that a history of abdominopelvic surgery is not a contraindication for single-port surgery; however, central obesity is problematic to secure a route for the single-port system through a small intraumbilical incision. Procedural difficulties resulting from previous abdominopelvic surgery are not because of the single-port surgery itself, but owing to abdominopelvic conditions [10, 15�C17]. A linear correlation existed between the operation time and an extirpated uterine weight of >400g, because more time was needed for uterine fragmentation for extirpation through the vagina; however, no linear correlation existed between the operation time and a uterus weight of <400g.

For pelvic adhesion, such as in previous pelvic surgery or endometriosis, additional operation time is required for adhesiolysis. This study has several limitations. It is not a case-control study, and pain score, hospital stay, cost effectiveness, and return to work were not considered because of Entinostat the retrospective nature of the study. Additional clinical data and long-term followup may be needed to address port-related complications.