Comparison of Safety and Efficacy of Transumbilical Single-Site Laparoscopic and Transvaginal Endoscopic Versus Conventional Multisite Laparoscopic Surgery for Benign Adnexal Masses: Systematic Review and Network Meta-Analysis

Background: Benign adnexal masses is one of the most common gynecological operations. With the innovation and development of surgical methods, minimally invasive surgery has become the mainstream surgical procedures. In previous studies, several articles have compared single-site laparoscopic surgery (LESS) and transvaginal endoscopic surgery with conventional laparoscopic surgery, but only a few articles have reported the comparison of LESS and transvaginal endoscopic surgery in benign adnexal masses, and most of the data were from a single research center with a small sample size. Objective: To indirectly compare LESS and transvaginal endoscopic surgery with conventional laparoscopy as the midpoint, in order to comprehensively evaluate the safety and effectiveness of three surgical procedures for benign adnexal tumors—conventional laparoscopic (CL) surgery, LESS, and vaginal natural orifice transoral endoscopic surgery (V-NOTES)—in a larger sample size and a more heterogeneous population sample size. Methods: The study was searched according to the online meta-analysis protocol of the Preferred Reporting System for Meta-Analysis reporting guideline. The study was included in studies published from January 1, 2018 to August 1, 2023. Results: V-NOTES, LESS, and multi-port laparoscopy were equally effective in successful resection of adnexal masses. The V-NOTES group had shorter operation time, lower postoperative intestinal function recovery time, lower visual analog scale 24-hour pain score, and shorter hospital stay. There were no significant differences in the other results among the three surgical methods. The ranking information suggested that V-NOTES was identified as the surgical method with better overall benefits for patients, followed by LESS. V-NOTES had postoperative complications. Conclusions: In the resection of benign adnexal masses, V-NOTES has certain advantages over CL. There is no significant difference between LESS and CL groups. In terms of the cumulative area under the curve, V-NOTES ranks first, and LESS ranks second. The specific surgical scheme recommended in clinical application needs to be further determined on the best indications for transumbilical single-port laparoscopy and transvaginal endoscopic surgery.