Laparoscopic, Robotic, and Laparoendoscopic Single-Site (LESS) Surgery: Applications in Female Urology and Urogynecology

Introduction

With the advent of laparoscopy in the late 20th century, urologists and gynecologists are now able to perform abdominal and pelvic surgeries in a minimally invasive manner. Traditional pelvic reconstructive techniques, which were limited to open abdominal operations with large incisions and long hospital stays, are now performed with smaller incisions and occasionally on an outpatient basis. Laparoscopy has provided surgeons with the ability to perform these procedures in a similar fashion to open procedures, albeit through much smaller incisions. Most laparoscopic procedures have less blood loss, and a quicker recovery compared to open surgery. However, in conventional laparoscopy, multiple trocars are required due to the limited degrees of freedom of the instruments and need for triangulation. A two-dimensional view of the surgical field further hampers surgical efforts.

Abstract

Traditional pelvic reconstructive and incontinence surgery required large abdominal incisions and carried significant morbidity for the patient. The introduction of laparoscopy and robotic-assisted laparoscopic surgery provided patients the option to have the same long-term outcomes with much smaller incisions and a significantly shorter recovery. Surgical technology has further evolved, and we are now offering patients laparoendoscopic single-site (LESS) surgery, which can be performed through a single incision, often through a natural orifice such as the umbilicus. This manuscript reviews the available literature on these minimally invasive techniques and how they have been applied in the field of female urology and urogynecology.

Keywords

Laparoscopy, robotics, pelvic organ prolapse, incontinence, stress, surgical procedures, minimally invasive