A Comparison Of Single-port Access Total Laparoscopic Hysterectomy (Spa-tlh) And Multi-port Access Total Laparoscopic Hysterectomy (Mpa-tlh): A Meta-analysis

Introduction: The objective of this study was to compare perioperative outcomes between single-port access total laparoscopic hysterectomy(SPATLH)and multi-port access total laparoscopic hysterectomy(MPA-TLH),to compare the advantages and disadvantages of the two surgical methods a nd to provide reference for clinical selection.Methods: Searching from foreign language databases: PubMed,Embas e,Web of Science,Cochrane Library,and Chinese databases: CBM,CNK I,VIP,and Wanfang.The retrieval time was from construction to March2019.Screening criteria-compliant literature according to inclusion criteria,and NOS quality assessment scale were used to evaluate the literature qua lity.Appling Review Manager5.3 software for statistical analysis.Results: A total of 12 references were included,including 515 patient s who underwent SPA-TLH and 612 patients who underwent MPA-TLH.Meta analysis showed that: the two study groups did not differ in termsof surgical outcomes except for operative time and patient satisfaction sco re.The SPA-TLH group had a longer operative time compared with the MPA-TLH group(MD=10.11,95%CI [5.96,14.26],P<0.00001).There were no differences in intraoperative blood loss(SMD =0.00,95%CI [-0.13,0.13],P=0.96),decreased HGB level(MD=0.02,95%CI [-0.24,0.29],P=0.88),conversion rates(OR=1.96,95%CI [0.64,6.02],P=0.24),complication r ates(OR=0.95,95%CI [0.60,1.51],P=0.83)and ureter or bladder injury(OR=1.00,95%CI [0.20,5.05],P=1.00),trusfusion rate(OR=0.73,95%CI [0.29,1.85],P=0.51),fever(OR=1.08,95% CI [0.58,2.02],P=0.81),wound disruption(OR=2.04,95%CI [0.37,11.31],P=0.42).There were not statistically significant in VAS scores(24h,MD =0.01,95%CI [-0.25,0.28],P=0.92;48h,MD=-0.09,95%CI [-0.27,0.10],P= 0.36),postoperative hospital stay(MD=-0.08,95%CI [-0.28,0.12],P=0.43),and time to first flatus(MD=-0.94,95%CI [-2.16,0.29],P=0.13).The patient satisfaction score is higher in SPA-TLH group than i n MPA-TLH group(MD=4.63,95%CI [2.33,6.93],P<0.0001).Conclusion: SPA-TLH may have better cosmetic outcomes,but it has no obvious advantages in postoperative pain,postoperative hospital stay a nd time to first flatus.Although the operative time of SPA-TLH is longer than MPA-TLH,the safety of them is equal.Due to the limited number of included literatures,it should be evaluated in a future randomized pro spective study.