Objective: The objective of this article is to review the current literature on
laparo-endoscopic single-site (LESS) surgery in gynecology, discuss recent developments, and
what is on the horizon for LESS surgery.
Design: Appraisal of articles published on the use of laparo-endoscopic single-site surgery in
gynecology from 2008 to the present. PubMed, Medline, and the Cochrane Central Register of
Controlled Trials were systematically searched using the terms “laparo-endoscopic single-site”,
“single-site laparoscopy”, “single port laparoscopy”, “SPA”, “SILS”, “LESS”, “robotic single-site
surgery”, and “R-LESS” between January 1, 2016 and February 15, 2016. Publication date restrictions
were all publications 2008 and later. Non-English language was excluded.
Results: LESS and R-LESS is safe, feasible, and equivalent to traditional multiport laparoscopy and
robotic surgery. Cosmesis is potentially the most obvious advantage associated with LESS surgery.
Instrument crowding with associated external instrument space conflicts is a major problem
since all the instruments are inserted through a single point on the abdomen. For the experienced
laparoscopist, the learning curve for LESS is shorter and associated with less morbidity when
compared to the learning curve of multiport laparoscopy.
Conclusion: LESS surgery is another option of approach to minimally invasive gynecologic
surgery. There is a clear body of literature demonstrating that LESS is feasible, safe, and equivalent
to traditional multiport and robotic surgery. There is growing literature regarding improved
cosmesis, improved pain control, quicker recovery, and shorter hospitalizations but these studies,
even when combined, are underpowered. Both traditional and robotic laparoendoscopic single site
surgeries are still in the early development and diffusion.