History of Cesarean Delivery Does Not Preclude LESS-H

Laparoendoscopic single-site surgery with hysterectomy (LESS-H) for benign disease with either a lateral or vaginal approach is a feasible procedure regardless of cesarean section history, reported the authors of a retrospective cohort study conducted in Korea.¹
   
Typically, the minimally invasive LESS-H procedure is associated with a short recovery period, minimal blood loss, low levels of pain, a short hospital stay, nominal scarring, and high levels of patient satisfaction. The goal of this study was to determine whether the surgical outcomes of LESS-H are typical in patients who have had a prior cesarean section. All patients included in this study had benign gynecological disease, cervical disease, or endometrial disease.
   
LESS-H, with either a vaginal approach or a lateral approach for bladder dissection, was performed in 98 women who have had a prior cesarean section and 202 women who have not had a prior cesarean delivery. Overall, the outcomes were similar between study groups. However, patients with a history of cesarean section had higher rates of adhesiolysis (P=0.002) and higher rates of LESS-H failure that required the use of additional trocars (P=0.041) compared with patients with no history of cesarean section.
   
The baseline demographics and clinical characteristics were similar between study groups, with the exception of age. In addition, the time to perform the procedure, the weight of the uterus, estimated blood loss, changes in hemoglobin values, the length of hospital stay, and the rates of transfusion did not differ between study groups.
   
Not including transfusion, the overall surgical complication rate was 2.67%, reported the study authors.¹ In the group with a history of cesarean section, there were 2 cases of injury to the bladder or ureter. Similarly, 2 cases of urologic complications were reported in the group with no history of cesarean section.
   
Based on these findings, the study authors concluded that LESS-H, with either a lateral or vaginal approach for bladder dissection, is a good surgical option in patients with benign gynecological, cervical, or endometrial disease, even among those who have had a prior cesarean section.¹ Although patients with a history of cesarean section were more likely to require adhesiolysis or additional trocars, the overall outcomes ultimately were similar between study groups.

Pertinent Points:
- LESS-H with either a lateral or vaginal approach for bladder dissection is a feasible procedure for patients with benign disease who have a history of cesarean section.
- Compared with patients with no history of cesarean section, patients who have had a prior cesarean section are more likely to require adhesiolysis and to need additional trocars during the LESS-H procedure.
 

References:

1. Jo EJ, Kim TJ, Lee YY, et al. Laparoendoscopic single-site surgery with hysterectomy in patients with prior cesarean section: comparison of surgical outcomes with bladder dissection techniques. J Minim Invasive Gynecol. 2013;20:160-165.