Technical, ergonomic and cognitive learning methodology in transumbilical single-port laparoscopic hysterectomy.

OBJECTIVE: We introduced learning curves on a detailed step protocol and ergonomic aspect to determine key surgical points in transumbilical single-port laparoscopic hysterectomy (TSPLH) and to popularize both technical and cognitive methodology on laparoendoscopic single-site surgery (LESS). MATERIALS AND METHODS: A retrospective analysis of 87 TSPLH procedures was conducted by a single surgeon in three learning stages. Technical, ergonomic, and cognitive steps were introduced, and surgical outcomes were analyzed. RESULTS: Key production points in TSPLH include developing a clear retroperitoneal space, maintaining appropriate strength and direction with a vaginal manipulator, coagulating the uterine artery, and applying an improved vaginal stump suturing method. Technical factors included instrument domination, hand-eye coordination, and alternating hand functions. Ergonomic techniques focused on shoulder, elbow, arm, wrist, and finger movements, range of motion, muscle power, continuous forces, and flexibility. Improved cognitive factors such as confidence, decision-making, and communication were also observed. CONCLUSIONS: The study aimed to form methodological education on TSPLH and LESS and benefit more surgeons. The detailed production and key ergonomic points will help guide self-learning and education.