Perioperative outcomes of laparoendoscopic single-site extracorporeal versus intracorporeal cystectomy for benign ovarian cysts: a retrospective cohort study based on propensity score matching

Background: Ovarian cysts are the most common gynecological disease, and laparo-endoscopic single-site (LESS) cystectomy is a popular surgical procedure. A new laparoscopic technique combining the advantages of LESS surgery and open surgery has been introduced to treat large ovarian cysts. To our knowledge, no previous research has compared LESS-extracorporeal (LESS-E) cystectomy to LESS-intracorporeal (LESS-I) cystectomy. This study compared the perioperative results of LESS-E cystectomy and LESS-I cystectomy in the treatment of benign ovarian cysts. Methods: Two hundred eighty-eight cases of cystectomy from our institutional database were retrospectively reviewed. 1:1 propensity score matching was performed to minimize bias due to any imbalanced baseline features between the 2 groups, which were matched in terms of age, body mass index, and the largest diameter of ovarian cysts. Seventy-nine cases were then selected from each group, and the perioperative outcomes of the 2 cohorts were analyzed. Results: The mean (standard deviation) largest diameter of ovarian cysts was 8.30 (3.56) cm in the LESS-I group and 9.14 (3.15) cm in the LESS-E group (P=0.118). No statistically significant difference was found between the 2 groups in terms of estimated blood loss, postoperative hemoglobin decline, postoperative pain in 24 hours, postoperative hospital stay, and total hospital costs (P>0.05). However, the mean operation time of the LESS-E group was shorter than that of the LESS-I group (85.01 vs. 104.25 minutes; P=0.001). Additionally, the spillage rate of the LESS-I group was significantly greater than that of the LESS-E group (46.8% vs. 17.7%; P<0.001). The mean pain scores at 6 postoperative hours as measured by a visual analogue scale were significantly greater in the LESS-I group than the LESS-E group (3.85 vs. 3.37; P=0.016). Conclusions: LESS-E cystectomy is a safe and feasible approach with a shorter operation time and lower spillage rate than LESS-I cystectomy.