The feasibility of gasless single-port access laparoscopy in overweight patients undergoing adnexal surgery

Objectives: To evaluate the feasibility and outcomes of gasless single-port access (SPA) laparoscopy in overweight patients undergoing adnexal surgery. Material and methods: A retrospective review was conducted on the medical records of 118 patients who underwent gasless SPA laparoscopic adnexal surgery using J-shaped or triangular-shaped retractors between May 2017 and June 2022. Patients were categorized into overweight (BMI ≥ 23) and standard-weight (BMI < 23) groups. Surgical characteristics and outcomes were compared between the two groups. Results: Out of 118 patients, 41 were in the overweight group, and 77 were in the standard-weight group. Significant differences were observed in age (p = 0.001), the number of previous abdominal surgeries (p = 0.001), and the number of subjects who had given birth (p = 0.004), all higher in the overweight group. There were no significant differences between the groups in setup time from umbilical skin incision to abdominal wall retraction, use of additional trocars operation time, estimated blood loss, or length of postoperative hospital stay. No serious intraoperative complications, such as urologic, bowel, and vessel injuries were noted in either group. Tumor diameter (p < 0.001), bilaterality (p < 0.001), presence of adhesion (p = 0.026), and setup diameter of the retractor (p = 0.001) significantly correlated with operation time in multivariate analysis (Adjusted R 2 = 0.645). Conclusions: Gasless SPA laparoscopic adnexal surgery in overweight patients is a feasible and effective alternative to conventional SPA laparoscopy, mitigating the potential negative effects of carbon dioxide gas.