Supplementary Material for: Hybrid Laparoendoscopic Single-Site Surgery Using a 2-mm Mini-Laparoscopic Instrument versus Conventional Three-Port Laparoscopy for Gynecologic Adnexal Diseases: A Prospective Randomized Trial

Background: Despite the advantages of laparoendoscopic single-site surgery (LESS), it has certain limitations that include longer surgical time, larger incision, and instrument collision. Objective: To overcome these limitations, we incorporated a suprapubic 2-mm needle forceps into our hybridized LESS (hLESS) and evaluated its efficacy for benign adnexal disease in comparison with three-port laparoscopy (TPL). Methods: This prospective study included 61 women randomly assigned in a 1:1 ratio. Incisions of 12 and 2 mm were made, respectively, at the umbilicus and suprapubic areas for hLESS. The length of surgery was compared. Postoperative pain was evaluated using a visual analog scale score, and consumption of analgesics. Cosmetic outcomes were assessed using a modified Vancouver Scar Scale and a body image questionnaire. Results: The length of surgery was found to be similar. The pain score 2-h postoperatively was significantly less in the hLESS group. The scar impact from the hLESS was significantly more favorable compared to that from the TPL. The patients in the hLESS group had a significantly better perception of their body image. Conclusion: Despite the reduced umbilical incision size and the absence of specialized instruments required in LESS, the hLESS revealed a similar surgical time, lower postoperative pain, and a better cosmetic outcome compared to TPL