Systematic review and meta-analysis of single-port versus conventional laparoscopic hysterectomy

BACKGROUND: The choice between single-port laparoscopic hysterectomy (SPLH) and conventional laparoscopic hysterectomy (CLH) remains unclear. OBJECTIVES: To evaluate the feasibility, safety, and comparative effectiveness of SPLH and CLH. SEARCH STRATEGY: PubMed, Web of Science, and the Cochrane Library were searched in February 2015 using combinations of the terms "single port," "single incision," "single site," "laparoscopic hysterectomy," and "laparoendoscopic hysterectomy." SELECTION CRITERIA: Randomized controlled trials (RCTs) and retrospective studies comparing SPLH and CLH were included if they reported at least one quantitative outcome. DATA COLLECTION AND ANALYSIS: Study characteristics, quality, and outcomes were assessed. The primary outcomes were procedure failure and perioperative complications. Odds ratio (ORs) and 95% confidence intervals (CIs) were calculated. MAIN RESULTS: Eighteen studies (6 RCTs, 12 retrospective studies) were included. As compared with CLH, SPLH had a higher failure rate (OR 6.37, 95% CI 3.34-12.14; P<0.001). The frequency of perioperative complications did not differ (OR 0.89, 95% CI 0.45-1.74; P=0.73). CONCLUSIONS: There is no significant difference in the frequency of perioperative complications between SPLH and CLH. However, the higher rate of procedure failure in SPLH should be taken into consideration.