Abstract
OBJECTIVE: This study aimed to evaluate the efficacy, safety, and patient-centered outcomes of single-port laparoscopic surgery (LESS) versus traditional multi-port laparoscopic surgery for benign ovarian cysts. METHODS: A retrospective cohort study enrolled 260 patients (January 2022-September 2025) divided into single-port group (n = 130, transumbilical LESS) and multi-port group (n = 130, conventional laparoscopy). Outcomes included perioperative indicators (operative duration, blood loss, time to first flatus/ambulation, hospital stay, 24-hour Visual Analogue Scale (VAS) pain), postoperative day-1 inflammatory markers (C-reactive protein (CRP), IL-6, procalcitonin), preoperative/1-3 month postoperative anti-Mullerian hormone (AMH) (ovarian reserve), hospitalization costs, and abdominal wall appearance satisfaction (POSAS). Propensity score matching (PSM) was used to reduce bias. RESULTS: After PSM, the single-port group had lower 24-hour VAS scores (2.36 ± 0.86 vs. 3.72 ± 1.30, P < 0.001), higher abdominal wall satisfaction (97.7% vs. 71.5%, OR = 16.8, P < 0.001), shorter time to first flatus (15.1 ± 2.9 vs. 21.1 ± 4.1 h), ambulation (13.6 ± 2.4 vs. 20.9 ± 3.2 h), and hospital stay (3.99 ± 0.60 vs. 5.33 ± 1.50 d, all P < 0.001). It also had lower costs (17,130 ± 3,793 vs. 19,036 ± 4,403 yuan) and inflammatory markers (all P < 0.001), and less postoperative shoulder pain (23.8% vs. 28.5%, OR = 8.03, P < 0.001). Operative duration, blood loss, and 1-3 month AMH showed no inter-group differences (all P > 0.05). No conversions, 30-day readmissions, or complication rate differences were observed (P > 0.999). CONCLUSION: LESS for benign ovarian cysts has comparable safety/efficacy to multi-port laparoscopy, with advantages of less pain, milder inflammation, faster recovery, lower costs, and better cosmetic satisfaction, while preserving ovarian reserve-making it a valuable minimally invasive option.