2. Surgical procedure

All surgeries were performed by a single surgeon (SH Shim). After general anesthesia, the patient was placed in the dorsal lithotomy position. A Cohen cannula was used for uterine manipulation and was handled by the second assistant. An approximately 2 cm intraumbilical skin incision was made, and a single port device (Glove port; Nelis, Bucheon, Korea) was installed transumbilically. Rounded distention of the abdomen after initial pneumoperitoneum was made adequately. The adnexal surgeries were performed with the monopolar or bipolar forceps, atraumatic forceps, scissors, toothed grasper, and a suction-irrigator. The tissue was placed in a 10 mm endobag and removed from the pelvic cavity via the 20 mm incision site. The inserted single port device was removed from the abdominal wall. Group 1 did not receive local injection and group 2 received 10 mL of 0.25% bupivacaine (100 mg) into the 20 mm trocar incision site at the end of LESS. Injecting the local anesthetic through all preperitoneal layers provided a full-thickness local injection. Bupivacaine (0.25%) was injected with a 22G needle. The fascia of the 20 mm puncture site was closed layer by layer with a 2-0 polyglactin suture (Vicryl, Ethicon Inc., Somerville, NJ, USA). The skin was closed by interrupted sutures with 3-0 resorbable monofilament suture (Monosyn, B. Braun, Melsungen, Germany).