Two port procedures are the latest development in ALS for GYN surgery. Only two 5 mm, or ¼ inch midline incisions are used, one placed at the belly button, and the second at the bikini line. Incisions placed at these midline sites eliminates injury to the muscles, and greatly decreases blood clot formation from muscle injury or blood vessel bleeding causing pain and discomfort after surgery. Traditional laparoscopic or robotic procedures use 4 to 5 incisions, many of which are placed laterally through the abdominal wall muscles. Two port procedures use only ¼ inch incisions. There is almost no risk for herniation of bowel or fat through the incision due to its small size. Standard laparoscopic or robotic procedures use incisions up to ¾ to 1 inch in size, increasing the risk of herniation. The placement of the incision and the incision size are also very important for a rapid recovery and decreased pain. Two port incisions are the smallest possible, and placement through the midline results in the least pain possible. Standard laparoscopic and robotic procedures use much larger incisions that are placed laterally, causing much more pain and complications following surgery. Most importantly, because only two port are used, the surgeon has total control of the procedure, and does not need a surgical assistant or resident to help with the operation. This greatly decreases complications and decreases the time needed to perform the operation. Decreased surgical time results in less anesthesia, which hastens the recovery.
Chart comparison Two Port vs. Four Port Standard vs. Robotic
| Two Port-WSC | Standard – OB/GYN | Robotics | |
| Number Port | 2 | 4 | 4 - 5 |
| Size Port | 5mm - ¼ inch | 2 – 5mm, 1- 10mm ¼ inch 1 – 12mm -3/4 inch |
3 – 8 mm 2 – 12 mm |
| Location Port | midline only | midline and lateral low | midline and lateral arc formation, upper |
| Bleeding at Port Site | Min | Mod to High | High |
| Herniation at Port Site | No | Yes | Yes |
| Assistant | No | Yes | Yes |
| Hospital Stay Average (days) | 0 | 1 | 1 to 1.5 |
| Post Op Pain | Min | Mod | Mod to Severe |
| Recovery (days) | 5 - 7 | 14 | 14 |
WSC developed the two port procedure, and has presented data about this procedure through an abstract presented at the November 2010 American Association of Gynecologic Laparoscopic Surgeons meeting. The interest in the procedure was exceptional, with WSC also presenting a two hour lecture on the application of two port procedures in GYN surgery through an Ethicon – Johnson and Johnson sponsored discussion.
The high level of interest in two port procedures has to do with the exceptionally fast recovery with these operations when compared to standard laparoscopy and robortics, and also the application of two port procedures to all aspects of GYN surgery. Two port operations can be used for following surgical procedures:
- Hysterectomy
- Fibroids up to 6 month size
- Pelvic pain
- Endometriosis
- Hyperplasia
- Uterine cancer
- Myomectomy
- Ovarian cystectomy and removal
- Endometriosis
- Prolapse procedures
- Pelvic pain with adhesion and scar tissue removal
- Appendectomy
A video presentation of the two port technique for hysterectomy and other procedures can be seen in video archives. For further information, please contact the Womens Surgery Center for a consultation with one of our physicians to discuss your needs.