Two-port laparoscopic adnexal surgery with a multichannel port using a wound retractor: is it safe and minimally scarring?

This study aimed to explore and evaluate the feasibility and safety of laparoscopic adnexal surgery using a two-port technique with a multichannel port, using a wound retractor, as previously reported. A series of patients undergoing two-port laparoscopy for a benign pelvic mass were enrolled in this study. To perform two-port laparoscopic surgery, the ancillary 5-mm trocar was inserted at the left iliac fossa under laparoscopic view after umbilical trocar insertion. The inserted umbilical trocar was removed and the skin incision was extended about 1.5 cm with index-finger-passable width. An Alexis wound retractor XS (Applied Medical, Santa Rancha Margarita, CA) was inserted through the umbilical wound. Two trocars were inserted into two fingers of a no. 6 surgical rubber glove and ligated with rubber bands. The wrist portion of the rubber glove covered the wound retractor, and the edge of the wound retractor was clamped with three Babcock clamps to prevent carbon-dioxide gas leakage. Both a 10-mm laparoscope and atraumatic forceps were inserted through the umbilical multichannel port. Laparoscopic adnexal surgery was performed in the usual manner. A total of 19 patients were enrolled. The operative procedures were adnexectomy (n = 8), myomectomy (n = 1), and ovarian cystectomy and/or salpingectomy (n = 10). There were no operative complications, conversion to laparotomy, or additional trocar insertions. The mean operation time was 81.3 +/- 28.7 min. The pathologic diagnosis were mature cystic teratoma (n = 6), benign cyst (n = 4), endometrial cyst (n = 3), serous cystadenoma (n = 3), mucinous cystadenoma (n = 1), leiomyoma (n = 1), and tubo-ovarian abscess (n = 1). The mean postoperative hospital stay was 4.0 +/- 1.3 days. This two-port method seems to be safe and needs no additional cost from the use of the conventional laparoscopic instruments. It is also cosmetically effective and highly appreciated by patients, leaving minimal abdominal scarring.