1. Single incision laparoscopic surgery (SILS) for ovarian tissue cryopreservation
Gilad Karavani 1, Natali Schachter-Safrai1, Henry H Chill 1, Talya Mordechai Daniel2, Dvora Bauman 1, Ariel Revel 1

2. Ovarian cortex cryopreservation

3. Is SILS oophorectomy better for fertility preservation?
Aim of study
Is SILS oophorectomy better for fertility preservation?

4. Planned chemotherapy and radiotherapy with possible induced ovarian toxicity.
229 patients
Madeleine: Only one is a wanderer; two together are always going somewhere. Vertigo, Hitchcock, 1958

5. Single port laparoscopic surgery

8. Basic characteristics
P value
OR (95% CI)
MPLS (n=163)
SILS (n=66)
Parameter
0.87
N/A
19.85±9.03
20.06±6.98
Age at OTC
0.46
0.74 ( )
32 (19.8%)
10 (15.2%)
Pre-pubertal at OTC
Diagnosis
0.15
1.55 ( )
62 (38.0%)
32(48.5%)
Hematological pathology
0.85
0.89 ( )
11(6.8%)
4(6.1%)
Sarcoma
0.11
0.46 ( )
29(17.8%)
6(9.1%)
Neurological malignancy
0.88
0.96( )
61(37.4%)
24(36.4%)
Carcinoma/other
0.09
1.81 ( )
28 (17.2%)
18 (27.3%)
Chemotherapy prior to OTC
Data are given as mean± SD or n (%)
OTC - ovarian tissue cryopreservation
SILS- single port laparoscopi surgery, MPLS- multiple port laparoscopic surgery.

9. Comparison of procedure details and outcomes- SILS vs. MPLS``
P value
OR (95% CI)
MPLS (n=163)
SILS (n=66)
Parameter
0.61
0.85 ( )
50 (30.3%)
18 (27.3%)
Partial oophorectomy
0.14
1.59 ( )
41 (25.1%)
23 (34.8%)
Port insertion
0.57
0.76 ( )
19 (11.5%)
6 (9.1%)
Bone marrow aspiration
0.79
N/A
69.2±45.7
70.8±23.3
Duration of OTC
0.26
2.54 ( )
3(1.8%)
3 (4.6%)
Overall Complications
0.52
2.49 ( )
1 (0.6%)
1 (1.5%)
Intra- operativea
0.36
2.52 ( )
2 (1.2%)
2 (3.0%)
Post- operativeb
0.87
1.13±0.60
1.14±0.61
Hospital stay (days) after OTC
0.5
8.8±8.1
8.0±7.8
N of oocytes (day 0)
<0.001
10.6±3.9
14.7±3.7
N of ampules extractedc
No difference was found in time from procedure (days) to definite treatment between SILS and standard laparoscopy (6.5.2 vs. 6.9±9.3 days, respectively; NS) when comparing procedures performed from 2010 (when SILS was initially performed). Number of ampules extracted from the preserved tissue was somewhat higher in the SILS group as compared to the standard laparoscopy group (14.7 vs. 10.6, respectively; p<0.01). Logistic regression models presented positive correlation between SILS in increasing age (between 1-20 years) and higher volume of preserved tissue.
a Intra-operative complication was defined as premature termination or failure of the procedure with a need for further intervention, excessive bleeding requiring blood transfusion or damage to adjacent organs
b Post-operative complication was defined as fever (>38 c) , Need for blood transfusion , superficial or deep surgical site infection or readmission within a week following the procedure
c Reflecting tissue volume. Each ampule contained 6-10 slivers of ovarian tissue for grafting

10. We conclude that our findings suggest that SILS is an interesting alternative to MPLS and in
future prospective trial may be shown to offer soma advantage in volume or time
until commencement of chemotherapy initiation.