Recent Advances in Laparoscopic Hysterectomy: Journey from Multiple Incision to Single Incision Hysterectomy

The benefits of surgical treatment of disease have always been viewed as being obtained with a certain acceptable level of pain and trauma to the patient. Minimizing this untoward effect of any surgical procedure has been a driving force of laparoscopy since its inception in the early 1900s.1,2 Even with the clear benefits of laparoscopy over open surgery,3 we have continued to see a trend toward fewer invasions in the quest for “scarless” surgery. Laparoscopic assisted vaginal hysterectomy (LAVH) was first performed by Reich in the year 1989. It has been implemented in hysterectomy procedures for uterine myomas and adenomyomas. Three or four laparoscopic ports are traditionally required to complete a LAVH. One port is inserted through the infraumbilical, and the other ports are usually inserted through the lateral abdominal wall muscles, suprapubis, or both.4 To minimize minimally invasive surgical techniques such as LAVH, single-portaccess (SPA) laparoscopic surgery has been developed.5-7