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No clear benefit of single incision surgery: ob-gyns

By Kerry Grens

NEW YORK (Reuters Health) - Research so far has not found obvious advantages to minimally invasive surgery involving just one cut, according to a leading organization of women's doctors.

Although single incision surgeries have become more popular in recent years, the evidence does not show they are any better for patients' health than other minimally invasive procedures, said Dr. Jessica Shepherd, one of the authors of the report from the American College of Obstetricians and Gynecologists (ACOG).

"The one benefit that it does have is improved cosmesis," or cosmetic appearance of the surgery site, said Shepherd, who is the director of minimally invasive gynecology at the University of Illinois Hospital and Health Sciences System in Chicago.

"Cosmetic benefit is still really important for women," she told Reuters Health.

Single incisions can be used for a variety of procedures, including removing the fallopian tubes, uterus, uterine fibroids or other masses, repairing a protruding vagina and "tying" a woman's fallopian tubes to prevent pregnancy.

It's not clear just how often single incision procedures are performed, but Shepherd said their increased use prompted ACOG to review the evidence on whether they are any better than conventional approaches to minimally invasive surgery.

Minimally invasive surgery, also called laparoscopy, typically involves several small cuts.

"The thought is, if you have one incision the pain will be less and cosmesis is potentially much better," said Dr. Ally Murji, a maternal-fetal medicine specialist at the University of Toronto and Mt. Sinai Hospital in Ontario, Canada.

But as the ACOG Committee on Gynecologic Practice found, there are very little data backing up the idea that women's pain is reduced when surgery involves just one cut.

Two studies did find some reduction in pain among women who had single site surgery, compared to those who underwent a standard minimally invasive procedure, whereas two other studies did not find any differences in women's reports of pain.

"The data that we do have from the pain aspect really (don't) show that single incision laparoscopy is superior at this point in time compared to conventional laparoscopy. It's probably equivalent," said Murji, who did not participate in the ACOG report.

He said the ACOG committee, who published their report in Obstetrics & Gynecology, did a thorough job of assessing the single site technique.

One analysis by Murji and his colleagues earlier this year found that single incision surgery appears to be just as safe as surgeries with several incisions.

"The disadvantages (are) it's technically much more challenging, and second is it does take more time than conventional laparoscopy, likely because it is more difficult to accomplish," he told Reuters Health.

A third drawback to the technique, Murji added, is that it could cost more if surgical tools have to be modified - although Shepherd said the same instrumentation can be used and the cost should not be any different.

Shepherd's group called for more research, particularly large studies comparing traditional minimally invasive surgery to single site operations.

In the meantime, having more surgical options available for women is a good thing, she said.

"We want to promote women knowing their options and being able to choose what's available," Shepherd said.

Murji agreed.

"I am optimistic and I'm encouraged that women have more of a choice," he said.

"But I caution that just because we can do something through a single incision surgery doesn't mean that we should be doing it. And we really have to see, is it beneficial before we begin offering it to everybody."

SOURCE: http://bit.ly/15fR9fP Obstetrics & Gynecology, online July 23, 2013.

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