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.

Introduction: Single-port access (SPA) laparoscopy requires only one incision, unlike conventional laparoscopy. However, its umbilical incision is larger than that of conventional laparoscopy and can be vulnerable to postoperative pain. This study aimed to evaluate whether simultaneous use of a continuous wound infiltration (CWI) system and intravenous patient-controlled analgesia (IV PCA) effectively decreases surgical site pain in patients who underwent SPA laparoscopy due to gynecologic adnexal disease.Methods: A total of 371 patients who underwent SPA laparoscopy and who received IV PCA or CWI was retrospectively reviewed (combined group [CWI + IV PCA, n = 159] vs. PCA group [IV PCA only, n = 212]). To evaluate postoperative pain management, the numeric rating scale (NRS) pain score after surgery, total amount of fentanyl administered via IV PCA, and additional pain killer consumption were collected.Results: The NRS scores at 12 h (1.90 ± 1.11 vs. 2.70 ± 1.08, p < 0.001) and 24 h (1.82 ± 0.82 vs. 2.11 ± 1.44, p = 0.026) after surgery were significantly lower in the combined group than in the PCA group. The total amount of PCA fentanyl was significantly smaller in the combined group than in the PCA group (p < 0.001). The total quantity of rescue analgesics was smaller in the combined group than in the PCA group (p < 0.05).Conclusion: Combined use of the CWI system and IV PCA is an effective postoperative pain management strategy in patient who underwent SPA laparoscopy for adnexal disease.

Background: Reduced-Port Robotic Surgery (RPRS) for myomectomy is feasible alternate method to overcome disadvantages of multiport and single-site platforms of robotic surgery with better cosmetic results. We demonstrated operative outcomes and long-term outcomes after RPRS. Methods: This is analysis of a prospective, non-randomized study of 115 patients who underwent RPRS from April 2016 through July 2021. Results: Overall 115 patients were included for analysis. Patients’ median age was 42 years (range, 28–52). The largest myoma was mostly located on the anterior uterine wall in 59 patients. The median myoma size and weight were 7.5 cm (range, 3–12) and 163 g (range, 42–753), respectively. The median myoma enucleation time and suture time were 10 minutes (range, 4–82) and 14 minutes (range, 5–63). Trend of shorter docking time and console time was shown with experience. The procedure was successfully performed via RPRS in 104 patients (91.5%); 10 patients required placement additional ports, conversion to open surgery was conducted in one case. There were 6 patients (5.2%) with postoperative complication with surgical wound infection (1.7%), bleeding (0.9%), peritonitis (1.7%), and pneumonia (0.9%). For long-term outcomes, 12 recurrences (10.4%) were observed in median follow-up of 25 months (range, 6–62 months). Total of 4 patients became pregnant after RPRS, and three patients had delivered with Caesarean section without complications. Conclusions: Our long-term results demonstrate the safety and feasibility of RPRS for uterine myomectomy as a valid treatment modality.