Outstanding Young Surgeon | Chen Chuan: Extrafascial Total Hysterectomy via Transumbilical Single-Port Laparoscopy

Key Surgical Points

Comprehensive Preoperative Evaluation and Planning
Clarify the scope of lesions and anatomical variations in the pelvic cavity. Evaluate the patient’s BMI, abdominal wall thickness, previous surgical history and scar conditions, and formulate a single-port access strategy in advance.
Establishment of Single-Port Access
Make a 2.5 cm longitudinal incision at the umbilicus and place a multi-channel operating platform. Maintain the triangular operating relationship between instruments as much as possible to reduce the "chopstick effect".
Layered Pelvic Anatomy
In accordance with extrafascial standards: completely resect the cervix; expose the ureteral tunnel; transect between the ureter and cervix; open the sacrouterine space, individually treat the sacrouterine ligament and resect 1 cm; circumcise the vagina by 1 cm.
Anatomy of Key Areas

Ureteral knee: Ensure the ureter is in a safe zone.
Pelvic wall vessel management: Master the branching course of the external iliac and internal iliac systems.
Vaginal resection and suturing: Ensure safe resection margins and effective hemostasis.

Hemostasis and Energy Device Application
Prioritize advanced energy devices (harmonic scalpel/bipolar). Adhere to the principle of "anatomy first, energy second". For small and scattered bleeding points, achieve efficient hemostasis and maintain a clear surgical field.

Surgical Challenges

Severe "chopstick effect" of single-port instruments
Parallel insertion of instruments limits traction, exposure and clamping. Proficiency in special techniques such as "reverse traction", "counter-traction" and "sky window" is required.
High difficulty in ureteral dissection
Layered dissection of the ureter is restricted under single-port vision.
Limited deep pelvic wall operation
High risk of energy convergence, which may damage the rectum, nerves and blood vessels.
Difficult vaginal vault resection and suturing
Compared with conventional laparoscopy, the suturing direction is unsatisfactory under single-port approach. Proficiency in single-port needle holding and suturing skills is required.

Surgical Highlights

Single-port minimally invasive surgery
Outstanding cosmetic effect: the umbilical incision is "invisible" with almost no scar after surgery; it better meets modern patients’ expectations for cosmetic and comfortable treatment.
Fully demonstrate the surgeon’s technical characteristics
Precise anatomy, clear layers, delicate operation and meticulous hemostasis.
Less intraoperative pain stimulation
The umbilicus is a congenital hernia ring area with few sensory nerves. Local infiltration anesthesia after surgery helps reduce incision pain.
More obvious advantages of enhanced recovery after surgery (ERAS)
Early postoperative ambulation, rapid recovery and short hospital stay.

Case History

Patient, 54 years old, admitted due to irregular postmenopausal vaginal bleeding for more than half a month.

Present Illness

The patient has been menopausal for more than 2 years. She had vaginal bleeding without obvious inducement half a month ago. Color Doppler ultrasound in an outside hospital suggested an intrauterine space-occupying lesion (10 mm9 mm6 mm). She underwent hysteroscopic endometrial polypectomy in an outside hospital on November 5, 2025, and pathology showed endometrial polyps with complex atypical hyperplasia of glands. She was admitted to our department for further treatment.

Obstetric History

3-0-1-3, all vaginal deliveries.

Surgical History

Bilateral tubal ligation more than 20 years ago; transcervical resection of polyp (TCRP) on November 5, 2025.

Past History

None.

Gynecological Examination

Vulva: parous type
Vagina: unobstructed, normal mucosa
Cervix: smooth
Uterus: anteverted, normal size, good mobility
Adnexa: no obvious abnormality on both sides
Triple examination: no thickening of cardinal and sacrouterine ligaments

Auxiliary Examinations

Pathology from outside hospital (November 8, 2025): endometrial polyps with complex atypical hyperplasia of glands.
Serum CA125 (November 21, 2025): 17.2 U/ml.
Enhanced MRI with diffusion (November 14, 2025, our hospital): post-hysteroscopy, endometrial thickening, uneven signal with a small amount of pelvic hematocele and hydrops; please combine with clinical findings. No enlarged lymph nodes in the pelvic cavity.

Diagnosis

Atypical endometrial hyperplasia.

Operation Name

Extrafascial total hysterectomy via transumbilical single-port laparoscopy.

Introduction to the Surgeon

Chen Chuan

Attending Physician, First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital)

Main focus: minimally invasive gynecology and gynecologic oncology. Solid foundation and proficient skills. Rich practical experience in gynecologic minimally invasive surgery, especially oncologic surgery. Proficient in minimally invasive techniques such as single-port laparoscopy, VNOTES and hysteroscopy.
Member of the Obstetrics and Gynecology Branch of Anhui Evidence-Based Medicine Association.
Published several medical papers and 1 utility model patent.
Second Prize in Surgical Video Competition at the 2023 Annual Meeting of Obstetrics and Gynecology Branch of Anhui Medical Association.
First Prize in Paper Competition at the 2025 Annual Meeting of Obstetrics and Gynecology Branch of Anhui Medical Association.
Third Prize in Surgical Video Competition at the 2025 Annual Meeting of Obstetricians and Gynecologists Branch of Anhui Medical Doctor Association.

Editor: Qing Huan

Reviewer: Ma Ye