The use of laparoscopy in gynecology is one of the most important technological advances in the field of obstetrics and gynecology in recent decades.
Procedures that previously required 20-30 cm longitudinal incisions in the patient’s abdominal wall have been significantly reduced. Instead, a variety of gynecologic procedures can be performed with as few as 3-5 small 0.5 to 1.5 cm incisions.
From simple ovarian cysts to more complex malignant diseases such as radical cervical cancer, we can now perform them all in this minimally invasive way. Patients can have their stitches removed at the time of discharge, even with absorbable sutures that do not need to be removed. This not only reduces the trauma to the patient and allows the patient to recover quickly from the surgery, but also reduces the chance of complications such as incisional dehiscence and infection. Currently, the vast majority of patients in my ward are operated on in this manner. This procedure is collectively referred to as the traditional laparoscopic technique. As technology advances and patient requirements for wounds further increase, a new scarless procedure, single-port laparoscopy, has emerged.
The so-called scarless surgery borrows the natural orifice of the body to form the surgical area, introduces surgical instruments to perform the operation, and closes the orifice when the surgery is completed so that no new scar is formed. Natural orifices are often hidden, such as the oral cavity, digestive tract, vagina, etc., and leave no trace on the body surface after the orifice is closed. This procedure requires completely new surgical instruments and therefore has only been developed in the last decade. The most common orifice for gynecologists is the vagina, so many gynecological procedures can be performed through it. However, the vagina itself contains bacteria, which can easily cause infections after surgery, and the narrow vagina is difficult to manipulate, making it difficult to perform transvaginal surgery to stop bleeding, complete adnexal surgery and myoma surgery.
Thanks to the development of new surgical instruments, it is possible to perform gynecological laparoscopic surgery using another natural scar and orifice without creating a new scar. This orifice is the belly button. The belly button is the site where the fetal umbilical cord attaches to provide nutrition and oxygen. After the umbilicus is severed the newborn forms a natural depression, the weakest part of the human abdominal wall. We use the belly button to form a 2 cm incision to place special instruments and imaging systems into the body to complete various gynecological procedures. Because there is only one orifice into the body, we call it a single-port laparoscope, thus distinguishing it from traditional laparoscopy.
The biggest advantage of single-port laparoscopy is less trauma, faster patient recovery, less postoperative pain, and no scarring of the abdominal wall after surgery. We suture the belly button and the incision is completely hidden after the local wound has healed. You can still wear your navel-less dress or three-point swimsuit and no one will notice that you have had surgery.
Single-port laparoscopy requires a full set of special instruments and imaging systems, and it is extremely difficult to access multiple instruments through a small hole to avoid interference and “fighting” between them. It requires a long learning curve for the surgeon to readjust to the new imaging and instrumentation, so it is often difficult for many surgeons skilled in traditional laparoscopic techniques to adapt.
We have gradually mastered this new technique over several years of experience and training, and have achieved good results in clinical practice.
The picture below shows the patient’s belly button incision the day after the single-port laparoscopic hysterectomy I completed. The incision is small and buried inside the belly button, which cannot be found if one does not pay close attention to it. The scar below is left from the patient’s last gynecological surgery, so it is clearer when you compare it.
At present, we can perform scarless surgery for a variety of gynecological diseases, such as common uterine diseases, ovarian cysts, infertility and ectopic pregnancy. After the operation, the patient’s pain is significantly reduced and recovery is fast, and he can be discharged in 2 days.