Abstract
This meta-analysis compares the efficacy and safety of Miniature Laparoscopy (MLS) and Laparo-Endoscopic Single-Site Surgery (LESS) for hysterectomy to assess their performance in minimally invasive gynecologic surgery.
A systematic review and meta-analysis of observational studies comparing MLS and LESS, with no follow-up due to the retrospective design.
Surgeries occurred in standard operating rooms with patients in lithotomy position, using setups for either multi-port MLS or single-port LESS techniques.
Included 481 women (266 MLS, 215 LESS) from five studies, selected for undergoing hysterectomy with MLS or LESS, covering data up to September 2024.
MLS involved multiple 3-mm ports and a 5-mm trocar; LESS used a single umbilical port with specialized tools.
Outcomes measured with RevMan included operative time, blood loss, hospital stay, VAS pain scores, ileus duration, and complications. Results showed similar operative time (MD = 2.89, P = 0.29) and blood loss (MD = 0.79, P = 0.80); MLS had lower pain scores at 2 hours (MD = -1.40, P = 0.003) and 24 hours (MD = -0.67, P = 0.001).
This is the first comparison of MLS and LESS, and adds evidence to the position that both are safe and effective for hysterectomy. MLS was linked to less pain at 2 and 24 hours, possibly due to its smaller incisions. These techniques have the potential to offer promising options for minimally invasive surgery, but more research is needed their advantages and associated risks, especially in the areas of enhanced recovery, ease of surgeon adoption, and patient satisfaction.