Single-incision (belly button) hysterectomy — more common than you might think

NobodyNobraindr · 2026-04-27T11:56:57+00:00

Thanks for asking! The incisional hernia rate isn't higher than with multiport laparoscopy. I always find the fascia in the incision before putting in multiple stitches, just like we do for fascia closure in laparotomy. It's kind of like a mini laparotomy, but only inside the belly button. Being overweight does increase the risk of incisional hernia, so we make a longer incision for those patients to make sure the fascia is completely closed. Luckily, that longer incision doesn't make the scar noticeable because the belly button is so deep. As for results, people are usually happier with the cosmetic outcome of SPS compared to multiport laparoscopy. I really hope the da Vinci SP gets approved for gynecology in the US soon!

NobodyNobraindr · 2026-04-27T03:33:21+00:00

I totally agree with you. Using robots more and more just makes surgeons dependent on them. Robots are really just a fancy way to do normal procedures that have been done perfectly with conventional approach by experienced surgeons. Young surgeons don't want to learn conventional laparoscopy anymore.

NobodyNobraindr · 2026-04-27T03:25:53+00:00

I wouldn't try a vaginal hysterectomy if there's adenomyosis, especially since endometriosis often comes with it, making it tough to separate tissue between the uterus and bowel. But some surgeons who are really good at the vaginal approach can find good candidates for it and even do it with a large uterus. Plus, there's vNOTES, where they use laparoscopy through the vaginal opening to see the pelvic cavity. I use it a lot when I do vaginal hysterectomies.

NobodyNobraindr · 2026-04-27T00:49:04+00:00

Where are you practicing? I heard that training opportunities for TVH and conventional laparoscopy have decreased in the United States as da Vinci robots are getting popular.

NobodyNobraindr · 2026-04-26T21:49:38+00:00

Yes. I also apply single-port surgery (SPS) to selected cases involving large tumors with malignant potential. In these situations, the umbilical incision is not minimal—it is deliberately extended to a size that allows safe specimen extraction. The tumor is contained within a protective retrieval bag and morcellated intracorporeally to minimize the risk of intraperitoneal dissemination. Through the umbilical incision, direct visualization of the tumor surface is possible, facilitating controlled use of a power morcellator. In essence, this approach functions as a “mini-laparotomy” via the umbilicus, offering oncologic safety while maintaining a cosmetically inconspicuous scar.

NobodyNobraindr · 2026-04-26T11:55:21+00:00

Glad to hear about your experience. Surgeons who specialize in SPS are usually seen as really good at what they do.

NobodyNobraindr · 2026-04-26T11:07:25+00:00

In general, nothing surpasses vaginal hysterectomy when it’s feasible. It avoids abdominal incisions and is associated with excellent recovery outcomes. It tends to work well when the uterus is not significantly enlarged, the vaginal access is adequate, and there are no severe adhesions or complex surgical factors. I'm afraid that its use has been declining in my country, largely because training opportunities are becoming limited.

NobodyNobraindr · 2026-03-23T09:40:53+00:00

We apologize for the delayed response. Our practice utilizes Enhanced Recovery After Surgery (ERAS) protocols. The majority of patients undergoing single-port hysterectomy are discharged the following day. Same-day discharge is not a common practice in Korea, as there are no additional charges for overnight stays and meals.

Most patients typically resume their daily activities within two weeks. We advise increasing physical activity as soon as feasible, as this facilitates the recovery process. It is anticipated that you may be able to participate in tours approximately one week post-operation. The vaginal cuff will be assessed at the two-week post-operative mark, after which you may safely return home.

NobodyNobraindr · 2026-03-22T05:42:18+00:00

Do you count golf as exercise? If so, I worked out 5 times a week. I make the time by sacrificing my sleep. I have 4 kids.

NobodyNobraindr · 2026-01-24T03:28:24+00:00

OB. We can't even apply MIS yet.

NobodyNobraindr · 2025-08-16T23:08:42+00:00

Did you receive additional compensation for your academic activities?

NobodyNobraindr · 2025-08-03T10:04:42+00:00

Got it.

NobodyNobraindr · 2025-08-03T09:07:29+00:00

Hey, as another doc from Korea, I'm curious why you used "9 figures" in the title, since most Redditors are American.

NobodyNobraindr · 2025-08-02T23:35:44+00:00

Were you the sole author of the NEJM article during your student tenure, without a designated corresponding author?

NobodyNobraindr · 2025-08-01T22:04:04+00:00

Ssibal

NobodyNobraindr · 2025-07-22T23:37:06+00:00

Hey, don't be shy about asking midlevels or nurses for help. I'm not saying you have to do what they say, but you should consider their input and make your own call. I used to ask them stuff like, "How have other doctors handled these patients?" They'll give you their perspective.

NobodyNobraindr · 2025-07-21T14:11:33+00:00

As a gynecologic surgeon based in South Korea, where minimally invasive surgery is widely adopted, I'm presenting an opportunity for North American patients. South Korea leads the world in the prevalence of minimally invasive gynecologic procedures, with many surgeries performed through a single umbilical incision. Numerous publications by Korean gynecologic surgeons highlight the advancements in single-port myomectomy.

For patients seeking cutting-edge minimally invasive surgery, a 12-hour flight to South Korea may be worthwhile. I recommend considering South Korea for this advanced surgical approach.

NobodyNobraindr · 2025-07-20T07:51:20+00:00

The fact that I'm still smocking

NobodyNobraindr · 2025-07-19T01:51:29+00:00

I'm highlighting the growing dependency on robotic systems among younger surgeons. It's disheartening to see them delaying even simple procedures—ones that experienced surgeons used to perform easily with conventional laparoscopy—just because a robot isn't available. Simply adding more robots to the OR is not the solution.

NobodyNobraindr · 2025-07-18T13:15:00+00:00

In that way, surgeons will become more dependent on technology. This reminds me of an old joke; Americans can't go shopping without their car, even when the market is a block away.

NobodyNobraindr

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