To present the first clinical report and detailed technique of Laparo-Endoscopic Single Site (LESS) simple hysterectomy.

We performed LESS simple hysterectomy in two cases. Indications included recurrent high-grade cervical intra-epithelial neoplasia and menometrorrhagia with anemia. LESS simple hysterectomy was performed using a single multi-lumen port inserted through a solitary 2.5 cm intraumbilical incision. Standard laparoscopic ultrasonic shears, Ligasure, needle drivers, articulating scissors, and specifically designed bent grasping instruments facilitated dissection and suturing. A vaginally inserted uterine manipulator facilitated retraction of the uterus during the procedure and the cervical ring identified the line of excision. All specimens were delivered and the vaginal cuff was suture repaired transvaginally.

The procedures were successfully completed transumbilically . Total operative time was 120 minutes (case 1) and 160 min (case 2), and estimated blood loss was 160 cc (case 1) and 110cc (case 2). No intraoperative or postoperative complications occurred. Hospital stay was 24 hours in both cases. Specimen final pathology revealed carcinoma in situ with glandular extention of the cervix (case 1) and myomatous uterus (case 2). Both patients are doing well without post-operative complications at a median follow-up of 4 months.

We demonstrate feasibility and describe the detailed surgical technique of LESS simple hysterectomy. Our initial experience suggests that it may be an attractive alternative for simple hysterectomy in lieu of open surgery, conventional laparoscopy, or robotic surgery. Comparative studies with other surgical techniques will determine its place in the surgical armamentarium for uterine and cervical pathology.