Single-port access (SPA) laparoscopic surgery and vaginal natural orifice transluminal endoscopic surgery (vNOTES) have many advantages. The objective of the present study is to compare patient characteristics, operative details, and postoperative outcomes between the two surgical methods. Patients who were planned to undergo vNOTES or SPA laparoscopic surgery between April 2020 and June 2021 were prospectively enrolled. The surgical method was determined by a single surgeon after imaging results evaluation and a physical exam. Those who had favorable pelvic conditions without any evidence of adhesion were scheduled for vNOTES. A total of 33 patients underwent a vNOTES hysterectomy while 40 patients received a SPA laparoscopic hysterectomy. All surgeries were performed by one surgeon. The proportion of the patients who had a history of vaginal delivery was significantly higher in the vNOTES group. The operative time for port installation was significantly longer in the vNOTES group, but the total operative time was shorter compared to the SPA group. The postoperative pain scores 12 h after the operations were also significantly lower in the vNOTES group. Other surgical outcomes were comparable between the two groups. The present study demonstrated that the early operative outcomes of vNOTES hysterectomy were comparable to those of SPA hysterectomy. It also highlights the importance of adequate patient selection when determining surgical methods based on imaging results and physical examinations.

The purpose of this study was to compare single-port access (SPA) laparoscopy and SPA robot assisted laparoscopy (RAL) for endometriosis with respect to ovarian reserve preservation and surgical outcomes. Clinical factors affecting any reduction in ovarian function after surgery were also evaluated. Patients with endometriosis who underwent SPA laparoscopy (n = 87) or RAL (n = 78) were retrospectively reviewed. Patients’ baseline characteristics, including the severity of endometriosis and surgical outcomes including surgical complexity, were collected. To assess the preservation of ovarian reserve after surgery, serum anti-Müllerian hormone (AMH) levels before surgery, at two weeks, and at three months after surgery were collected. Age, ovarian cyst size, location of cyst, complexity of surgery, and the severity of endometriosis were associated with the reduction in AMH levels after surgery. The severity of endometriosis was higher in the RAL group than in the SPA group. There were no significant differences in other clinical baseline characteristics, including preoperative AMH levels. For surgical outcomes, radical surgery was more frequently performed in the RAL group. In univariate and multivariate linear regression analyses, age, ovarian cyst size, location of cyst, complexity of surgery, and the severity of endometriosis were associated with the reduction in AMH levels after surgery. Incorporating surgical approaches and risk factors for postoperative ovarian function decrease, RAL was more beneficial than SPA laparoscopy for the preservation of ovarian reserve in patients with mild endometriosis (stage I/II) (postoperative 3 month AMH reduction rate (%), SPA laparoscopy vs. RAL, 33.51 ± 19.98 vs. 23.58 ± 14.98, p = 0.04) and in patients who underwent non-complex surgery (postoperative 3 month AMH reduction rate (%), SPA laparoscopy vs. RAL, 37.89 ± 22.37 vs. 22.37 ± 17.49, p = 0.022). SPA RAL may have advantages over SPA laparoscopy in ovarian function preservation, especially in patients with mild endometriosis and patients who have undergone a non-complex surgery.

Background: The aim of this study was to determine whether continuous wound infiltration (CWI) can replace intravenous patient-controlled analgesia (IV PCA) and to investigate effective pain control strategies after a single-port access (SPA) laparoscopy for adnexal disease. Methods: A total of 470 patients (the CWI group [n = 109], the IV PCA group [n = 198], and the combined group [n = 163]) who underwent an SPA adnexal laparoscopy and who received CWI or IV PCA for postoperative pain management were retrospectively reviewed. The numeric rating scale (NRS) pain score at 6, 12, 24, and 48 h (h) after surgery and the total amount of fentanyl administered via IV PCA were collected. The incidence of postoperative nausea and vomiting (PONV) and the total amount of rescue antiemetic drugs administered were also evaluated. Results: The mean NRS pain scores at 6 h (combined vs. PCA vs. CWI, 3.08 vs. 3.44 vs. 3.96, p < 0.001), 12 h (2.10 vs. 2.65 vs. 2.82, p < 0.001), and 24 h (1.71 vs. 2.01 vs. 2.12, p < 0.001) after surgery were significantly lower in the combined group. CWI showed a similar pain-reduction effect after surgery compared to IV PCA, except for the acute phase (within 6 h after surgery). The incidence of PONV during the entire hospitalization period was significantly lower in the CWI group compared to the groups using IV PCA (p < 0.05). The combined group had a significantly lower incidence of PONV and use of rescue antiemetics than the IV PCA group (p < 0.05). The combined group required significantly less total PCA fentanyl compared to the IV PCA group (combined vs. PCA, 622.1 μg vs. 703.1 μg, p < 0.001). Conclusions: CWI is an effective alternative to IV PCA and has fewer side effects. Combined use of CWI and IV PCA may be an ideal pain management strategy, offering a strong pain-reduction effect and only moderate side effects.

Background: This study evaluated age-related differences in postoperative pain and analgesic requirements after single-port access (SPA) laparoscopy for adnexal disease under three analgesic regimens. Methods: This retrospective cohort study included 470 patients stratified into: 55 years ( n = 75). Patients received continuous wound infiltration (CWI) alone, intravenous patient-controlled analgesia (IV PCA) alone, or combined CWI + IV PCA. NRS pain scores at 6, 12, 24, and 48 h were the primary outcomes. Multivariable regression adjusted for analgesic regimen, surgery type, and body mass index, with additional adjustment for endometriosis in sensitivity analysis. Results: Unadjusted NRS scores did not differ among age groups. Rescue nonsteroidal anti-inflammatory drug use was higher in patients aged <40 years at 0–6, 6–12, and 24–48 h. After adjustment, patients aged <40 years had significantly higher NRS scores at 24 h ( β = 0.276, p = 0.046). Combined CWI and IV PCA was associated with the lowest postoperative pain scores across age groups; however, a formal age × treatment interaction was not statistically significant. Sensitivity analysis yielded consistent findings. Conclusions: Younger age (<40 years) was independently associated with modestly higher postoperative pain at 24 h after SPA adnexal laparoscopy, although this difference was below the minimal clinically important difference. These findings may inform individualized analgesic planning, pending confirmation in prospective studies.

Background/Objectives: Opioid-based intravenous patient-controlled analgesia (IV-PCA) provides postoperative analgesia but can cause adverse effects that lead to early discontinuation. In relatively limited procedures such as single-port access (SPA) adnexal laparoscopy, the balance between analgesic benefit and opioid-related adverse effects remains uncertain. We evaluated the frequency of and recorded reasons for early IV-PCA discontinuation, associated factors, postoperative pain, and length of stay. Methods: We retrospectively reviewed 431 patients who received IV-PCA after single-port access (SPA) adnexal laparoscopy at two institutions. Early discontinuation was defined as permanent cessation before completion of the planned course. Associations with demographic and operative factors, concurrent continuous wound infiltration, and treating institution were examined. Repeated-measures analysis accounted for discontinuation timing and repeated pain assessments. Results: IV-PCA was discontinued early in 13.9% of patients. Among patients who discontinued IV-PCA, 85.0% had nausea or vomiting recorded as the reason for discontinuation. Of 59 patients with valid timing data, 47 (79.7%) discontinued within 24 h. No measured factor was significantly associated with discontinuation after adjustment. Unadjusted mean pain scores were 0.30, 0.39, and 0.28 points higher at 6, 12, and 24 h, respectively, but these differences were not significant after correction for multiple comparisons. Repeated-measures analysis showed no overall pain difference (+0.09 points, 95% CI −0.21 to +0.39). A secondary analysis suggested variation over time, but no time-specific estimate was statistically significant. Length of stay was similar between groups. Conclusions: Early IV-PCA discontinuation after SPA adnexal laparoscopy was mainly attributed to nausea or vomiting. These findings do not establish whether opioid-based IV-PCA is necessary or should be avoided in this setting; rather, they highlight the need to balance its potential analgesic benefit against opioid-related adverse effects and to prospectively evaluate alternative multimodal analgesic strategies.