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Goo TT, Agarwal A, Goel R, Tan CTK, Lomanto D, Cheah WK. Single-Port Access Adrenalectomy: Our Initial Experience. J Laparoendosc Adv Surg Tech A 2011; 21:815-9. [DOI: 10.1089/lap.2011.0179] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Tiong Thye Goo
- Department of Surgery, Minimally Invasive Surgical Centre, National University Hospital, Singapore, Singapore
| | - Amit Agarwal
- Department of Surgery, Minimally Invasive Surgical Centre, National University Hospital, Singapore, Singapore
| | - Rajat Goel
- Department of Surgery, Minimally Invasive Surgical Centre, National University Hospital, Singapore, Singapore
| | - Charles Tse Kuang Tan
- Department of Surgery, Minimally Invasive Surgical Centre, National University Hospital, Singapore, Singapore
| | - Davide Lomanto
- Department of Surgery, Minimally Invasive Surgical Centre, National University Hospital, Singapore, Singapore
| | - Wei Keat Cheah
- Department of Surgery, Minimally Invasive Surgical Centre, National University Hospital, Singapore, Singapore
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Fichera A, Zoccali M, Felice C, Rubin DT. Total abdominal colectomy for refractory ulcerative colitis. Surgical treatment in evolution. J Gastrointest Surg 2011; 15:1909-16. [PMID: 21909842 DOI: 10.1007/s11605-011-1666-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 08/09/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Total abdominal colectomy is the procedure of choice for debilitated patients with acute, medical refractory ulcerative colitis in our practice. A laparoscopic approach has been previously shown to be safe and effective, and has become our preferred strategy. This study illustrates the laparoscopic evolution towards a truly minimally invasive approach comparing three phases of a single colorectal surgeon experience. MATERIAL AND METHODS In May 2010 single incision laparoscopy was introduced in our practice and has become our preferred approach. Ten consecutive ulcerative colitis patients were case matched and compared with 10 previous laparoscopic-assisted (Feb 2003-Jan 2007) and 10 hand-assisted (Feb 2006-Apr 2010) total abdominal colectomies. Patient, disease and surgery-related factors were analyzed and short-term outcomes were compared. RESULTS Given the study design, there were no differences in demographics, smoking history, disease duration and severity, nutritional and inflammatory parameters, and indication for surgery between groups. Single incision patients were more likely to have received immunosuppressive therapy within 30 days of the surgery (p = 0.016). In the single incision group we noticed significantly shorter duration of surgery (p < 0.001) and faster resumption of solid diet (p = 0.019) compared to the other groups. Other short-term outcomes did not differ between groups. CONCLUSION Single incision laparoscopy offers a safe alternative to other laparoscopic approaches. Despite the higher technical complexity, the duration of surgery is shorter with faster resumption of oral intake. Studies with larger sample size and longer follow-up will be required to confirm the benefits of this approach.
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Affiliation(s)
- Alessandro Fichera
- Department of Surgery, University of Chicago Medical Center, Chicago, IL 60637, USA.
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Abstract
• Robotics of the current day have advanced significantly from early computer-aided design/manufacturing systems to modern master-slave robotic systems that replicate the surgeon's exact movements onto robotic instruments in the patient. • Globally >300,000 robotic procedures were completed in 2010, including ≈98,000 robot-assisted radical prostatectomies. • Broadening applications of robotics for urological procedures are being investigated in both adult and paediatric urology. • The use of the current robotic system continues to be further refined. Increasing experience has optimized port placement reducing arm collisions to allow for more expedient surgery. Improved three-dimensional camera magnification provides improved intraoperative identification of structures. • Robotics has probably improved the learning curve of laparoscopic surgery while still maintaining its patient recovery advantages and outcomes. • The future of robotic surgery will take this current platform forward by improving haptic (touch) feedback, improving vision beyond even the magnified eye, improving robot accessibility with a reduction of entry ports and miniaturizing the slave robot. • Here, we focus on the possible advancements that may change the future landscape of robotic surgery.
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Affiliation(s)
- Alexei Wedmid
- Division of Urology, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA 19104, USA
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Single-incision laparoscopic total abdominal colectomy for refractory ulcerative colitis. Surg Endosc 2011; 26:862-8. [PMID: 21959686 DOI: 10.1007/s00464-011-1925-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 06/02/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND A three-stage restorative proctocolectomy with ileal pouch-anal anastomosis is the treatment of choice for the particularly debilitated patient with medically refractory ulcerative colitis (UC). Laparoscopic surgery has been shown to offer several advantages over the open approach in this setting. Single-incision laparoscopic surgery is an emerging minimally invasive strategy representing a truly scarless procedure for the first surgical step, namely, the total abdominal colectomy (TAC). METHODS Nine consecutive patients with medically refractory UC underwent a single-incision laparoscopic TAC between May and October 2010. All patients were on aggressive medical therapy with corticosteroids or immunosuppressors and were selected for this approach on the basis of their body habitus and the absence of relevant comorbidities. The whole operation was performed through a single access to the abdominal cavity, placed at the ostomy site marked preoperatively. RESULTS Mean operating time was 142 ± 23 min, with an estimate blood loss of 108 ± 125 ml. No intraoperative complications or conversions to conventional laparoscopy or open surgery occurred. In all cases the postoperative course was uneventful. The return of bowel function was observed on postoperative day 1.7 ± 0.7, and patients could tolerate a solid diet on postoperative day 3 ± 0.5. The mean postoperative length of stay was 5.2 ± 1.3 days. CONCLUSIONS In our experience, a single-incision laparoscopic approach to total abdominal colectomy for refractory ulcerative colitis has been shown to be safe and feasible. Initial results suggest that this technique can lead to improvements in short-term outcomes in selected patients.
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Spana G, Rane A, Kaouk JH. Is robotics the future of laparoendoscopic single-site surgery (LESS)? BJU Int 2011; 108:1018-23. [DOI: 10.1111/j.1464-410x.2011.10513.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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56
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Greaves N, Nicholson J. Single incision laparoscopic surgery in general surgery: a review. Ann R Coll Surg Engl 2011; 93:437-40. [PMID: 21929912 PMCID: PMC3369327 DOI: 10.1308/003588411x590358] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2011] [Indexed: 01/07/2023] Open
Abstract
Single incision laparoscopic surgery (SILS) is a rapidly developing field that may represent the future of laparoscopic surgery. The major advantage of SILS over standard laparoscopic surgery is in cosmesis, with surgery becoming essentially scarless if the incision is hidden within the umbilicus. Only one incision is required so the risk of potential complications like port site hernias, haematomas and wound infection is reduced. The trade-off for this is a technically more challenging procedure with different underlying principles to that of traditional laparoscopic surgery. A wide variety of new equipment has been developed to support SILS and the range of procedures that are amenable to the technique is increasing. To date most of the published data relating to SILS are in the form of case series, with the first large randomised controlled trials due to be completed by the end of 2012. The existing evidence suggests that SILS is similar to standard laparoscopic surgery in terms of complication rates, completion rates and post-operative pain scores. However, the duration of SILS is longer than equivalent laparoscopic procedures. This article discusses SILS with regard to its applications in general surgery and reviews the evidence currently available.
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Urologic Laparoendoscopic Single-Site Surgery (LESS): current status. Urologia 2011; 78:32-41. [PMID: 21452159 DOI: 10.5301/ru.2011.6448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2011] [Indexed: 12/23/2022]
Abstract
BACKGROUND The evolution of minimally invasive surgery led to the development of laparo-endoscopic single-site surgery (LESS). DISCUSSION The feasibility of almost all types of urologic procedures has been shown. Comparative series between conventional laparoscopy and LESS for different kidney procedures suggest a non-inferiority of LESS over standard laparoscopy but the only objective benefit remains an improved cosmetic outcome. Challenging ergonomics, instruments clashing, lacks of true triangulation, in-line vision are the main concerns of LESS surgery. LESS pre-bent and articulating instruments have been designed but only experienced laparoscopists and well-selected patients are pivotal for a successful LESS procedure. Da Vinci® assisted LESS procedures have been performed. The available robotic platform remains bulky, but innovative instruments and platforms may facilitate the future unrestricted development of LESS. CONCLUSIONS A steep learning curve limits the application of LESS procedures to well trained and experienced surgeons. Nevertheless, the adoption of LESS principles and the clinical experience with LESS techniques have significantly grown in the past few years worldwide. Improvements in the instruments and platforms will expand the application of LESS surgery, allowing us to better assess its advantages and disadvantages compared to other minimally invasive procedures.
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Gash KJ, Goede AC, Kaldowski B, Vestweber B, Dixon AR. Single incision laparoscopic (SILS) restorative proctocolectomy with ileal pouch-anal anastomosis. Surg Endosc 2011; 25:3877-80. [PMID: 21761270 DOI: 10.1007/s00464-011-1814-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 05/12/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Restorative proctocolectomy with ileoanal pouch is the definitive procedure in ulcerative colitis. The potential benefits afforded by a single incision laparoscopic (SILS) approach make it appropriate to consider. METHODS Electronic data were prospectively collected from all patients who underwent SILS restorative proctocolectomy (SILS-RPC) between June 2009 and June 2010. RESULTS Ten consecutive patients (4 male), with median BMI = 22 (range = 20-28 kg/m(2)) underwent SILS-LRPC over a 1-year period. Three had undergone a previous emergency laparoscopic colectomy. A single-port device (Covidien SILS™ or Olympus TriPort™) was positioned at the site of the existing or proposed temporary ileostomy (2.5-cm incision). The colon and rectum were extracted through the SILS site (n = 8) or transanally following a mucosectomy (n = 2). A 20-cm J pouch was constructed extracorporeally and returned via the ileostomy site. Pouch-anal anastomosis was performed intracorporeally (n = 8) or hand-sutured (n = 2) and a diverting loop ileostomy was created at the SILS port site. The median operation time was 185 min (range = 100-381). There were no conversions or additional ports required. Median time to full diet was 36 h (range = 4-48 h) with a median hospital stay of 3 days (range = 2-8 days). There were no 30-day readmissions. Complications included surgical emphysema with temperature and a panic attack. Nine stomas have been closed. All patients have spontaneity of defecation, with a median pouch frequency of four per day, including once at night. All are fully continent and able to defer during the day. One reported a dry ejaculate for 10 weeks. CONCLUSION SILS restorative proctocolectomy is safe with good early functional outcomes when performed by an experienced laparoscopic surgeon.
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Affiliation(s)
- K J Gash
- Department of Colorectal Surgery, Frenchay Hospital, Bristol, UK
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Symes A, Rane A. Urological applications of single-site laparoscopic surgery. J Minim Access Surg 2011; 7:90-5. [PMID: 21197251 PMCID: PMC3002016 DOI: 10.4103/0972-9941.72394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 08/27/2010] [Indexed: 01/31/2023] Open
Abstract
Single-port, single-incision laparoscopy is part of the natural development of minimally invasive surgery. Refinement and modification of laparoscopic instrumentation has resulted in a substantial increase in the use of laparoendoscopic single-site surgery (LESS) in urology over the past 2 years. Since the initial report of single-port nephrectomy in 2007, the majority of laparoscopic procedures in urology have been described with a single-site approach. This includes surgery on the adrenal, ureter, bladder, prostate, and testis, for both benign and malignant conditions. In this review, we describe the current clinical applications and results of LESS in Urological Surgery. To date this evidence comes from small case series in centres of excellence, with good results. Further well-designed prospective trials are awaited to validate these findings.
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Affiliation(s)
- Andrew Symes
- Department of Urology, East Surrey Hospital, Redhill, U.K
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Garey CL, Laituri CA, Ostlie DJ, Snyder CL, Andrews WS, Holcomb GW, St Peter SD. Single-incision laparoscopic surgery in children: initial single-center experience. J Pediatr Surg 2011; 46:904-7. [PMID: 21616250 DOI: 10.1016/j.jpedsurg.2011.02.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 02/11/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND In continued efforts to further improve the advantages of minimally invasive surgery to patients, surgeons have developed single-incision laparoscopic techniques. We report our initial experience in children with a variety of single-site procedures. METHOD A retrospective chart review was performed on patients who underwent a single-site procedure from April 2009 to April 2010. RESULTS There were 142 consecutive procedures: 24 cholecystectomies, 103 appendectomies for nonperforated appendicitis, 2 splenectomies, 1 combined splenectomy/cholecystectomy, 8 ileocecectomies, 2 Meckel diverticulectomies, 1 small bowel duplication resection, and 1 jejunal stricture resection. There were 12 conversions to conventional laparoscopy: 10 during appendectomy and 2 during cholecystectomy. Mean operative time was 34 minutes for appendectomy, 73 minutes for cholecystectomy, 90 minutes for splenectomy, 116 minutes for combined splenectomy/cholecystectomy, 86 minutes for ileocecectomy, and 43 minutes for the small bowel procedures. The only complications were umbilical surgical site infections after appendectomy in 6 patients. CONCLUSION This institution's preliminary experience suggests that single-incision laparoscopic surgery in children has at least comparable outcomes to conventional laparoscopic surgery. However, prospective data are needed to prove that single-incision laparoscopic surgery is superior to conventional laparoscopy.
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Affiliation(s)
- Carissa L Garey
- Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108, USA
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61
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Rane A, Cindolo L, Schips L, De Sio M, Autorino R. Laparoendoscopic single site (LESS) adrenalectomy: technique and outcomes. World J Urol 2011; 30:597-604. [PMID: 21519852 DOI: 10.1007/s00345-011-0678-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 04/08/2011] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To describe the surgical technique, to analyze outcomes and to provide an overview of the current status of laparoendoscopic single site (LESS) adrenalectomy. METHODS A comprehensive PubMed search was performed for all relevant urological literature regarding LESS and adrenal surgery. In addition, experience gained at the authors' own institutions was considered. Clinical descriptive and comparative reports on LESS adrenal surgery procedures were analysed. RESULTS LESS adrenal surgery has been effectively performed for a number of indications. A wide variety of approaches (transperitoneal versus retroperitoneal, multichannel trocar versus multiple ports, trans- or extraumbilical) have been described. LESS adrenalectomy seems to be safe, taking more time than the standard laparoscopic counterpart but appears to offer the patient less postoperative discomfort. Technical difficulties of the procedure include the requirement of more time for adjustment of articulating instruments, longer 'one-handed' manipulation time, and a high peroperative tissue re-grasping rate. CONCLUSIONS The feasibility and safety of LESS adrenalectomy has been demonstrated. Only long-term follow-up outcomes will prove its benefits over conventional laparoscopy and define the role and the oncological safety of LESS adrenal surgery.
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Affiliation(s)
- Abhay Rane
- Department of Urology, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK.
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62
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Chambers WM, Bicsak M, Lamparelli M, Dixon AR. Single-incision laparoscopic surgery (SILS) in complex colorectal surgery: a technique offering potential and not just cosmesis. Colorectal Dis 2011; 13:393-8. [PMID: 20002691 DOI: 10.1111/j.1463-1318.2009.02158.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIM Single-incision (or port) laparoscopic surgery (SILS) has recently emerged as a method to improve morbidity and cosmetic benefit of conventional laparoscopic surgery. The literature contains two reports of SILS right hemicolectomy, and we report our experience of this technique. METHOD Seven consecutive, unselected patients underwent SILS retrocaecal appendicectomy, right hemicolectomy, extended right hemicolectomy, colectomy with ileorectal anastomosis, proctocolectomy, anterior resection and restorative proctocolectomy/ileoanal pouch using a single Triport (Olympus Keymed, Southend, UK), conventional instrumentation and nerve block analgesia. Three had undergone previous surgery, two had cancer and two were immunosuppressed. RESULTS Umbilical, right- and left-iliac fossa SILS was feasible using conventional instruments. Operative time ranged between 23 and 195 min (median 48 min). Four patients tolerated normal diet within 6 h (12-16 h for the remainder). Only one patient required postoperative enteral morphine (10 mg × 4). Discharge occurred between 8 and 90 h (median 16 h) of surgery. A secondary haemorrhage from the ileorectal anastomosis was managed conservatively. CONCLUSION SILS colorectal resection is feasible and safe when performed by an experienced laparoscopic surgeon and theatre team. It may have advantages over conventional laparoscopic surgery in terms of reduced pain, lower cost, faster recovery and cosmesis.
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Implementation of single incision laparoscopic appendectomy (SIL-A) as standard procedure for appendectomy in a rural hospital setting. Eur Surg 2011. [DOI: 10.1007/s10353-010-0584-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zhang X, Shi TP, Li HZ, Ma X, Wang BJ. Laparo-Endoscopic Single Site Anatomical Retroperitoneoscopic Adrenalectomy Using Conventional Instruments: Initial Experience and Short-Term Outcome. J Urol 2011; 185:401-6. [PMID: 21167534 DOI: 10.1016/j.juro.2010.09.084] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Indexed: 01/01/2023]
Affiliation(s)
- Xu Zhang
- Department of Urology, Chinese People’s Liberation Army General Hospital, Military Postgraduate Medical College, Beijing, People’s Republic of China.
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65
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Khanna R, White MA, Autorino R, Laydner HK, Isac W, Yang B, Altunrende F, Hillyer SP, Spana G, Haber GP, Kaouk JH, Stein RJ. Selection of a Port for Use in Laparoendoscopic Single-siteSurgery. Curr Urol Rep 2011; 12:94-9. [DOI: 10.1007/s11934-011-0174-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Roy P, De A. Single-incision laparoscopic intraperitoneal onlay mesh hernioplasty for anterior abdominal wall hernia: A safe and feasible approach. J Minim Access Surg 2011; 7:37-9. [PMID: 21197241 PMCID: PMC3002005 DOI: 10.4103/0972-9941.72377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 06/23/2010] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Single-incision laparoscopic surgery is being increasingly performed in experienced laparoscopic centres. The primary aim is at improving the cosmetic outcome of surgery without compromising the safety of the operation. The challenge of this surgery lies in limited range of movement of the instruments due to proximity of working ports and limited triangulation. METHODS We describe our first four consecutive cases of single-incision laparoscopic intraperitoneal onlay mesh hernioplasty for anterior abdominal wall hernia repair during a period of June to July 2009. Operative time, hospital stay and postoperative pain were assessed, and follow up was done for 3 months. RESULTS Three patients were discharged on first postoperative day and one on second postoperative day without any complications. CONCLUSIONS Based on our experience, we believe that the procedure is feasible without additional risk. Cosmetic benefit is clear; however, beyond that the actual outcome with respect to patient recovery, postoperative pain and long-term complications needs to be evaluated and compared to standard laparoscopic intraperitoneal onlay mesh hernioplasty.
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Affiliation(s)
- Prabal Roy
- Department of General and Minimally Invasive Surgery. Asian Institute of Medical Sciences, Faridabad, Haryana, India
| | - Anushtup De
- Department of General and Minimally Invasive Surgery. Asian Institute of Medical Sciences, Faridabad, Haryana, India
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Shi TP, Zhang X, Ma X, Li HZ, Zhu J, Wang BJ, Gao JP, Cai W, Dong J. Laparoendoscopic single-site retroperitoneoscopic adrenalectomy: a matched-pair comparison with the gold standard. Surg Endosc 2010; 25:2117-24. [PMID: 21170658 PMCID: PMC3116116 DOI: 10.1007/s00464-010-1506-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 11/15/2010] [Indexed: 12/22/2022]
Abstract
Background Laparoscopic adrenalectomy has become the gold-standard for the surgical treatment of most adrenal lesions. This study evaluated the operative outcome of laparoendoscopic single-site (LESS) retroperitoneoscopic adrenalectomy (LESS-ARA) in comparison with the current standard operation procedure. Methods Between June and December 2009, 19 patients underwent LESS-ARA, and their outcomes were compared with a contemporary 1:2 matched-pair cohort of 38 patients who underwent standard ARA by the same surgeon. In LESS-ARA, a multichannel port was inserted through a 2.5- to 3.0-cm transverse skin incision below the tip of the 12th rib. The LESS-ARA procedure was performed using a 5-mm 30º laparoscopic camera and two standard laparoscopic instruments. The following parameters were compared between the two groups: demographics, details of the surgery, perioperative complications, postoperative visual analog pain scale score, analgesic requirement, and short-term measures of convalescence. Results The finding showed that LESS-ARA and standard ARA were comparable in terms of the estimated blood loss (30 vs 17.5 ml; p = 0.64), postoperative hospital stay (6 vs 6 days; p = 0.67), and postoperative complications (2 vs 3 patients; p = 1.00) for patients with similar baseline demographics and median tumor size (2.1 vs 3.0; p = 0.18) cm. The intraoperative hemodynamic values were similar in the two groups. The LESS-ARA group had a longer median operative time (55 vs 41.5 min; p = 0.0004), whereas the in-hospital use of analgesics was significantly less (5 vs 12 morphine equivalents; p = 0.03). Conclusions The LESS retroperitoneoscopic adrenalectomy approach is feasible and offers a superior cosmetic outcome and better pain control, with perioperative outcomes and short-term measures of convalescence similar to those of the standard approach, albeit with a longer operative time.
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Affiliation(s)
- Tao-ping Shi
- Department of Urology, Chinese People's Liberation Army General Hospital, Military Postgraduate Medical College, 28 Fuxing Road, Haidian District, 100853, Beijing, China
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Chiruvella A, Sarmiento JM, Sweeney JF, Lin E, Davis SS. Iatrogenic combined bile duct and right hepatic artery injury during single incision laparoscopic cholecystectomy. JSLS 2010; 14:268-71. [PMID: 20932382 PMCID: PMC3043581 DOI: 10.4293/108680810x12785289144593] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Numerous recent reports describe the performance of laparoscopic procedures through a single incision. Although the feasibility of this approach for a variety of procedures is currently being established, little data are available regarding safety. CASE REPORT A 65-year-old female patient who was transferred from an outside institution had undergone a single incision laparoscopic cholecystectomy that resulted in biliary tract and vascular injuries. METHODS The patient was transferred with a known bile duct injury on the first postoperative day following single incision laparoscopic cholecystectomy. Review of her magnetic resonance imaging and percutaneous transhepatic cholangiogram studies showed a Bismuth type 3 bile duct injury. Hepatic angiogram demonstrated an occlusion of the right hepatic artery with collateralization from the left hepatic artery. She was initially managed conservatively with a right-sided external biliary drain, followed 6 weeks later by a Hepp-Couinaud procedure to reconstruct the biliary tract. CONCLUSION As new techniques evolve, it is imperative that safety, or potential side effects, or both safety and side effects, be monitored, because no learning curve is established for these new techniques. In these initial stages, surgeons should have a low threshold to add additional ports when necessary to ensure that procedures are completed safely.
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Affiliation(s)
- Amareshwar Chiruvella
- Department of Surgery, Suite H-124, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA 30322, USA.
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69
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Adair J, Gromski MA, Lim RB, Nagle D. Single-incision laparoscopic right colectomy: experience with 17 consecutive cases and comparison with multiport laparoscopic right colectomy. Dis Colon Rectum 2010; 53:1549-54. [PMID: 20940605 DOI: 10.1007/dcr.0b013e3181e85875] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recently, single-incision laparoscopic surgery has begun to develop as an extension of standard laparoscopic minimally invasive procedures. However, there have been a limited number of reports of single-incision procedures in colorectal disease. PURPOSE The aim of this study is to describe our initial experience with single-incision laparoscopic right colectomy and to make comparisons with the current standard of care, multiport laparoscopic right colectomy. METHODS Data from consecutive patients undergoing single-incision laparoscopic right colectomy were analyzed and compared with case-matched multiport laparoscopic right colectomies. Indications for surgery, type of port used, operative time, number of nodes harvested, length of hospital stay, and complications were the outcomes measured. RESULTS During the study period, 17 patients underwent single-incision laparoscopic colectomy. Of the planned single-incision laparoscopic cases, 15 (88%) were completed with a single incision, whereas 2 required an additional port placement. There were no conversions to open surgery during any of the cases. Indications for surgery were similar between the 2 groups. Operative time was not significantly different in single-incision laparoscopic right colectomy compared with multiport laparoscopic right colectomy (139 min vs 134 min, respectively; P = .61). Length of stay and number of nodes harvested also had no significant differences between the 2 groups. There was one death after discharge to home secondary to pulmonary embolism and one delayed thermal injury in the single-incision laparoscopic group. CONCLUSION Single-incision laparoscopic right colectomy is feasible, and appears to have results similar to standard multiport right colectomy in our initial comparisons. Ongoing development in instrumentation may help to further shorten operative time and minimize complications, and may make this an equivalent or preferred method for minimally invasive colorectal surgery. Large, prospective, randomized, controlled trials should be conducted to further compare the safety and efficacy of this approach.
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Affiliation(s)
- James Adair
- Department of Surgery, Section of Minimally Invasive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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70
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Agha A, Hornung M, Iesalnieks I, Glockzin G, Schlitt HJ. Single-Incision Retroperitoneoscopic Adrenalectomy and Single-Incision Laparoscopic Adrenalectomy. J Endourol 2010; 24:1765-70. [DOI: 10.1089/end.2010.0238] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Ayman Agha
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Matthias Hornung
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Igors Iesalnieks
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Gabriel Glockzin
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Hans J. Schlitt
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
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71
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Single-incision laparoscopic percutaneous extraperitoneal closure for inguinal hernia in children: an initial report. Surg Endosc 2010; 25:1531-4. [PMID: 20976481 DOI: 10.1007/s00464-010-1430-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 09/27/2010] [Indexed: 12/23/2022]
Abstract
BACKGROUND This report describes the first use of single-incision, two-port access for single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) to manage inguinal hernia in children. METHODS Between December 2009 and April 2010, 92 SILPECs of inguinal hernia and hydrocele were performed for 62 patients at Osaka City University Graduate School of Medicine. The SILPEC technique was performed using two ports (a 4.2-mm port placed using the open technique and an additional 4.2-mm port) inserted through the same periumbilical skin incision with different entrances through the abdominal wall. A 19-gauge LPEC needle (a special instrument with a wire loop at the tip to hold the material for circuit suturing around the internal inguinal ring) was used to close the orifice of the hernial sac extraperitoneally with circuit suturing around the internal inguinal ring. Data regarding patient demographics, type of hernia, operating time, complications, postoperative hospital stay, and recurrence were prospectively collected. RESULTS The mean operative time was 26.9 min. The estimated blood loss was almost nil, and no intraoperative complications occurred. CONCLUSION The use of SILPEC for inguinal hernia and hydrocele in children appears to be safe, effective, and reliable.
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72
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Chung SD, Huang CY, Wang SM, Tai HC, Tsai YC, Chueh SC. Laparoendoscopic single-site (LESS) retroperitoneal adrenalectomy using a homemade single-access platform and standard laparoscopic instruments. Surg Endosc 2010; 25:1251-6. [PMID: 20848138 DOI: 10.1007/s00464-010-1352-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 08/17/2010] [Indexed: 12/30/2022]
Abstract
BACKGROUND This study aimed to evaluate laparoendoscopic single-site (LESS) adrenalectomy via the retroperitoneal approach using the Alexis wound retractor with standard laparoscopic instrumentation. METHODS Since October 2009, seven LESS retroperitoneal adrenalectomies have been completed successfully with a homemade single port created using an Alexis wound retractor as an access platform through a 3-cm incision beneath the tip of the 12th rib. RESULTS All the LESS procedures for these seven patients with adrenal tumors (size, 1.3-6.0 cm; 4 right, 1 left) were completed successfully without traditional laparoscopic conversion or complication. The average operative time was 159 min, and the estimated blood loss was 100 ml. The average hospital stay was 2 days (range, 1-3 days). CONCLUSIONS The preliminary results show that LESS retroperitoneal adrenalectomy is a safe and feasible procedure for functional adrenal tumors using standard laparoscopic instruments.
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Affiliation(s)
- Shiu-Dong Chung
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan
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73
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Walz MK, Groeben H, Alesina PF. Single-access retroperitoneoscopic adrenalectomy (SARA) versus conventional retroperitoneoscopic adrenalectomy (CORA): a case-control study. World J Surg 2010; 34:1386-90. [PMID: 20213204 DOI: 10.1007/s00268-010-0494-4] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Stimulated by the concept of Natural Orifice Transluminal Endoscopic Surgery (NOTES), minimizing the access even further has become a new trend in minimally invasive surgery. We compare our recently described new method of endoscopic single-access adrenalectomy with the conventional retroperitoneoscopic approach in a matched-pairs study. METHODS Fifty single-access retroperitoneoscopic adrenalectomies (SARA) were performed in 47 selected patients suffering from Conn's adenomas (n = 20), pheochromocytomas (n = 15), Cushing's adenomas (n = 6), and other diseases (n = 6). For SARA, a single 2-cm skin incision beneath the 12th rib was used. Following creation of the retroperitoneal space with the rigid endoscope, dissection was carried out single-handed. Another 47 patients served as control group; they were treated by the traditional retroperitoneoscopic three-port approach (CORA). Patients were matched with respect to gender, body mass index, diagnoses, tumor size, and tumor site. RESULTS Mortality was zero and no major complications occurred in both groups. SARA was completed in 41 cases (86%). The overall complication rate was 8.5% in SARA and 6.4% in CORA. Operative time was longer for SARA (56 +/- 28 min) than for CORA (40 +/- 12 min) (P < 0.05). Postoperatively, pain medication was administered in 47% of SARA patients and in 75% of CORA patients (P = 0.01). Mean hospital stay was 2.4 +/- 0.7 days (SARA) and 3.1 +/- 1.2 days (CORA) (P < 0.01). CONCLUSIONS Because feasibility and safety of SARA could be demonstrated in a large group of selected patients, this surgical technique may represent a new milestone in minimally invasive endocrine surgery.
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Affiliation(s)
- Martin K Walz
- Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Henricistrasse 92, 45136, Essen, Germany.
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74
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Roberts KE, Panait L, Duffy AJ, Bell RL. Single-port laparoscopic umbilical hernia repair. Surg Innov 2010; 17:256-60. [PMID: 20798095 DOI: 10.1177/1553350610378514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Laparoscopic umbilical herniorrhaphy is preferred when abdominal wall defects exceed 3 cm. The authors describe a novel single-port laparoscopic technique for umbilical hernia repair. METHODS A total of 10 patients underwent single-port laparoscopic umbilical hernia repair. A 10-mm endoscope with a working channel was placed in the left upper quadrant. The abdominal wall defect was covered with a circular mesh with pretied sutures and needles attached. The mesh was secured to the abdominal wall with intraabdominal sutures without the need for transfascial suture fixation. RESULTS The average age of the patients was 43 years, and the average BMI was 34 kg/m(2). All procedures were completed laparoscopically. The mean operative time was 73 minutes. No major intraoperative or postoperative complications were encountered. CONCLUSIONS Single-port laparoscopic umbilical hernia repair is a safe and easily reproducible novel technique. It can help reduce possible complications from multiple-port sites.
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Affiliation(s)
- Kurt E Roberts
- Section of Gastrointestinal Surgery, Yale School of Medicine, New Haven, CT 06510, USA.
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75
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Autorino R, Cadeddu JA, Desai MM, Gettman M, Gill IS, Kavoussi LR, Lima E, Montorsi F, Richstone L, Stolzenburg JU, Kaouk JH. Laparoendoscopic single-site and natural orifice transluminal endoscopic surgery in urology: a critical analysis of the literature. Eur Urol 2010; 59:26-45. [PMID: 20828918 DOI: 10.1016/j.eururo.2010.08.030] [Citation(s) in RCA: 187] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Accepted: 08/17/2010] [Indexed: 02/07/2023]
Abstract
CONTEXT Natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) have been developed to benefit patients by enabling surgeons to perform scarless surgery. OBJECTIVE To summarize and critically analyze the available evidence on the current status and future perspectives of LESS and NOTES in urology. EVIDENCE ACQUISITION A comprehensive electronic literature search was conducted in June 2010 using the Medline database to identify all publications relating to NOTES and LESS in urology. EVIDENCE SYNTHESIS In urology, NOTES has been completed experimentally via transgastric, transvaginal, transcolonic, and transvesical routes. Initial clinical experience has shown that NOTES urologic surgery using currently available instruments is indeed possible. Nevertheless, because of the immaturity of the instrumentation, early cases have demanded high technical virtuosity. LESS can safely and effectively be performed in a variety of urologic settings. As clinical experience increases, expanding indications are expected to be documented and the efficacy of the procedure to improve. So far, the quality of evidence of all available studies remains low, mostly being small case series or case-control studies from selected centers. Thus, the only objective benefit of LESS remains the improved cosmetic outcome. Prospective, randomized studies are largely awaited to determine which LESS procedures will be established and which are unlikely to stand the test of time. Technology advances hold promise to minimize the challenging technical nature of scarless surgery. In this respect, robotics is likely to drive a major paradigm shift in the development of LESS and NOTES. CONCLUSIONS NOTES is still an investigational approach in urology. LESS has proven to be immediately applicable in the clinical field, being safe and feasible in the hands of experienced laparoscopic surgeons. Development of instrumentation and application of robotic technology are expected to define the actual role of these techniques in minimally invasive urologic surgery.
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Affiliation(s)
- Riccardo Autorino
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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76
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Gash KJ, Goede AC, Chambers W, Greenslade GL, Dixon AR. Laparoendoscopic single-site surgery is feasible in complex colorectal resections and could enable day case colectomy. Surg Endosc 2010; 25:835-40. [PMID: 20734083 DOI: 10.1007/s00464-010-1275-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 07/13/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fast-track surgery accelerates recovery, reduces morbidity, and shortens hospital stay. However, the benefits of laparoscopic versus open surgery remain unproven within a fast-track program. Case reports of laparoendoscopic single-site (LESS) colectomies are appearing with claims of cosmetic advantage and decreased parietal trauma. This report describes the largest case series of LESS colorectal surgery and its effects on recovery. METHODS In this series, 20 consecutive unselected patients underwent LESS colorectal surgery including right hemicolectomy (n = 3), extended right hemicolectomy, high anterior resection (n = 2), low anterior resection involving total mesorectal excision (TME; n = 3), ileocolic anastomosis (n = 2, including 1 redo surgery), colectomy and ileorectal anastomosis (n = 4, including 1 with ventral mesh rectopexy), panproctocolectomy (n = 2), proctocolectomy and ileoanal pouch (n = 2) and an abdominoperineal excision of rectum. Single-port conventional instrumentation and transversus abdominus plane (TAP) block analgesia were used. The indications included cancer (n = 8), Crohn's disease (n = 4), ulcerative colitis (n = 3) complicated diverticulosis (n = 2), and slow-transit constipation (n = 3). Eight of the patients had undergone previous surgery. RESULTS Most of the cases (90%) were managed successfully using the LESS technique and conventional instrumentation. Two operations (10%) were converted to standard laparoscopy, due to insufficient theater time and an unstable port. The operative time ranged from 45 to 240 min (median, 110 min). A normal diet was tolerated within 6 h by 7 patients and in 12 to 16 h (overnight) by 11 patients. Complications included anastomotic bleed (n = 1), ileus (n = 2), acute renal failure secondary to hyperphosphatemia and hypocalcemia (n = 1), urine retention (n = 1), and wound infection (n = 1). The median hospital stay was 46 h (range, 7-384 h). Eight patients were discharged within 24 h. There was one readmission (5%). CONCLUSION Laparoendoscopic single-site colorectal resection using conventional instrumentation is feasible and safe when performed by an experienced team. The LESS approach may have advantages in terms of minimal pain, cosmesis, lower costs, and faster recovery. A randomized trial is required to confirm whether LESS offers a true patient benefit over standard laparoscopic resection.
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Affiliation(s)
- K J Gash
- North Bristol NHS Trust, Frenchay Hospital, Bristol, BS16 1LE, UK
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77
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Single-incision Laparoscopic surgery for total extraperitoneal repair of inguinal hernias in 23 patients. Surg Laparosc Endosc Percutan Tech 2010; 20:114-8. [PMID: 20393339 DOI: 10.1097/sle.0b013e3181d848c3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Laparoscopic surgery has long been the treatment of choice for recurrent or bilateral hernias, and for unilateral hernias when the patient does not want to undergo open surgery. Each laparoscopic incision or trocar presents risks for hemorrhage, organ injury, incisional hernia, and poor cosmetic outcome. For this reason, single-incision laparoscopic surgery (SILS) is being increasingly used to treat a variety of conditions. The aim of this study was to evaluate the use of SILS for total extraperitoneal (TEP) repair of hernias in the largest series performed to date. PATIENTS AND METHODS During the period from June to September 2009, 23 consecutive patients underwent SILS for TEP repair of inguinal hernias. SILS was performed under general anesthesia, with the use of a single access port device and articulating as well as standard laparoscopic instruments. Demographic and clinical data, intraoperative findings, and postoperative course were recorded. RESULTS In the 23 patients (mean age 48.4 y; 18 males and 5 females), a total of 27 hernias were repaired. Unilateral hernias were present in 19 patients and bilateral hernias in four. Of the unilateral hernias, 11 were on the right and 8 on the left. Indirect hernias occurred in 15 patients, direct hernias in 7 patients, and a direct+indirect hernia was seen in 1 patient. All hernias were repaired successfully with SILS except in 1 patient. In this patient, due to the large size of the hernia and the presence of adhesions, the procedure was converted to a standard laparoscopic TEP repair. Mean operative times for unilateral and bilateral hernias were 48.4 minutes (range: 32-62 min) and 96.7 minutes (range: 85-120 min), respectively. None of the patients experienced intraoperative or postoperative complications. Mean hospital stay was 1.17 days. CONCLUSIONS The use of SILS for TEP repair of hernias provides excellent cosmetic results, and articulating instruments seem to be useful for this procedure.
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78
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Jeong CW, Park YH, Shin CS, Kim HH. Synchronous Bilateral Laparoendoscopic Single-Site Adrenalectomy. J Endourol 2010; 24:1301-5. [DOI: 10.1089/end.2010.0097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Yong Hyun Park
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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79
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Single-incision laparoscopic TAPP mesh hernioplasty using conventional instruments: an evolving technique. Langenbecks Arch Surg 2010; 395:1157-60. [PMID: 20524008 DOI: 10.1007/s00423-010-0656-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 05/18/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this pilot study is to assess the safety, feasibility, and short-term outcomes of single-incision laparoscopic trans-abdominal preperitoneal (TAPP) mesh hernioplasty using conventional laparoscopic instruments. METHODS During a 3-month study period, data from all consecutive patients referred for inguinal hernia repair to the general and minimally invasive surgery unit of our institution who agreed to undergo single-incision TAPP mesh hernioplasty were included in the prospective study. Outcome measures included completion rate of the attempted procedure, operative time, length of hospital stay, postoperative pain, and assessment of complications. Follow-up was done for 3 months. RESULT Fifteen patients completed our protocol. Two patients had bilateral inguinal hernias while all other patients had unilateral hernia. Two patients had sliding hernia on the left side which had sigmoid colon as content. None of the patients required any additional port. There were no intraoperative complications. CONCLUSIONS The concept of laparoscopic single-incision surgery is an attractive and understandable innovation as laparoscopic surgery has become more commonplace. Based on our experience, we believe that the procedure is feasible without additional risk. Cosmetic benefit is clear; however, beyond the actual outcome with respect to postoperative pain and long-term complications, needs to be evaluated and compared to standard laparoscopic TAPP mesh hernioplasty.
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80
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Cindolo L, Gidaro S, Neri F, Tamburro FR, Schips L. Assessing Feasibility and Safety of Laparoendoscopic Single-Site Surgery Adrenalectomy: Initial Experience. J Endourol 2010; 24:977-80. [DOI: 10.1089/end.2009.0535] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Luca Cindolo
- Urology Unit, S. Pio da Pietrelcina Hospital, Vasto (CH), Italy
| | - Stefano Gidaro
- Urology Unit, S. Pio da Pietrelcina Hospital, Vasto (CH), Italy
- Department of Surgical and Experimental Sciences, Chieti–Pescara University, Chieti, Italy
| | - Fabio Neri
- Urology Unit, S. Pio da Pietrelcina Hospital, Vasto (CH), Italy
| | | | - Luigi Schips
- Urology Unit, S. Pio da Pietrelcina Hospital, Vasto (CH), Italy
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81
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Abstract
Videoscopic surgery has become the standard approach for most thoracic, abdominal, and pelvic procedures in adults and children. These procedures have widely recognized benefits including decreased postoperative pain, improved cosmesis, and decreased convalescence. In a recent attempt to further improve the cosmetic result of these operations, surgeons have begun to employ a single incision through which all the operating instruments are placed. This article seeks to review the current and future application of innovative minimally invasive surgery to pediatric surgery.
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82
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Liatsikos E, Kallidonis P, Kyriazis I, Al-Aown A, Stolzenburg JU. Urologic laparoendoscopic single-site surgery. Nat Rev Urol 2010; 6:654-9. [PMID: 19956195 DOI: 10.1038/nrurol.2009.217] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Laparoendoscopic single-site surgery (LESS) probably represents the next evolutionary step in laparoscopic surgery. Although most urologic procedures are feasible by the LESS approach, significant challenges in terms of intraoperative ergonomics and requirement for laparoscopic skill are present. New, specially designed instruments and ports represent a solution for combating ergonomic problems during surgery. Documentation of the advantages of LESS over other approaches is currently lacking, as comparative clinical trials are scarce in the literature; in the absence of such information, the technique has been accepted at centers of laparoscopic expertise. Thus, further prospective randomized clinical trials are necessary to fully characterize the outcomes of LESS.
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Affiliation(s)
- Evangelos Liatsikos
- Department of Urology, University of Patras, Medical School, Rion, 26 500, Patras, Greece.
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83
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Ryu DS, Park WJ, Oh TH. Retroperitoneal laparoendoscopic single-site surgery in urology: initial experience. J Endourol 2010; 23:1857-62. [PMID: 19814700 DOI: 10.1089/end.2009.0254] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To present our initial experience with single-port laparoscopic urologic surgery via the retroperitoneal approach using the Alexis wound retractor with flexible laparoscopic instrumentation. PATIENTS AND METHODS Since December 2008, 14 patients have undergone single-port laparoscopic surgery for various urological diseases, including renal cyst decortication in 5 patients, adrenalectomy in 2 patients, nephroureterectomy in 2 patients, nephrectomy in 3 patients, and ureterolithotomy in 2 patients. For the retroperitoneal approach, the Alexis wound retractor with a single port was used. RESULTS All cases were completed without conversion to standard laparoscopic or open surgery. The mean operative time and mean estimated blood loss for decortication of the renal cysts were 56 minutes (range 45-70 minutes) and 179 mL (range 22-398 mL), respectively; the mean operative time and mean estimated blood loss for extirpative or reconstructive surgery were 156 minutes (range 115-21 minutes) and 403 mL (range 35-1324 mL), respectively. The mean hospital stay was 6.5 days (range 4-14 days). There were no major intraoperative complications, but wound dehiscence and bleeding were noted in two patients. CONCLUSION Retroperitoneal single-port laparoscopic urologic surgery, particularly in patients requiring free-hand suturing, is technically feasible. The initial clinical experience of organ-ablative, extirpative, and reconstructive surgery with this approach is reported.
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Affiliation(s)
- Dong-Soo Ryu
- Department of Urology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
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84
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Koyanagi T, Motomura S. Transumbilical single-incision laparoscopic surgery: application to laparoscopically assisted vaginal hysterectomy. Arch Gynecol Obstet 2010; 283:305-9. [PMID: 20084387 DOI: 10.1007/s00404-010-1358-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 01/05/2010] [Indexed: 10/20/2022]
Abstract
PURPOSE Transumbilical single-incision laparoscopic surgery has been used more frequently in general surgery to reduce the invasiveness of traditional laparoscopy. However, few reports of single-incision laparoscopic surgery have been described in the field of gynecology. We used single-incision laparoscopic surgery to laparoscopically assisted vaginal hysterectomy (LAVH). We performed single-incision LAVH in ten patients and compared the operative results with the conventional multiport, multi-incision LAVH. METHODS We began applying single-incision LAVH in July 2009 and completed this method for uterine myoma in ten cases. Operative time, weight of resected uterus, and body mass index (BMI) were recorded and compared to those of conventional multiport LAVH. RESULTS Comparative outcomes of single-incision LAVH versus conventional multiport LAVH were as follows. The mean operative time was 76 ± 15.5 versus 71.4 ± 21.7 min (P = 0.57). The mean weight of resected uterus was 366.3 ± 144 versus 354 ± 95.5 g (P = 0.85). BMI was 23.3 ± 2.75 versus 22.2 ± 3.76 kg/m(2) (P = 0.52). No significant difference was observed between single incision and conventional LAVH. CONCLUSIONS Single-incision LAVH can be undertaken safely and with similar operative results to conventional multiport LAVH. We consider that it is a promising alternative method for the treatment of some patients with uterine myomas as incision-free gynecological operation.
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Affiliation(s)
- Takahiro Koyanagi
- Department of Obstetrics and Gynecology, Yanagawa Hospital, Yanagawa, Japan.
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85
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Neri F, Cindolo L, Gidaro S, Schips L. The LESS (Laparo-Endoscopic Single-Site) Procedure in Urology. Technical and Clinical Aspects. Urologia 2010. [DOI: 10.1177/039156031007700103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Minimally invasive urology is rapidly advancing, and single-site laparoscopic surgery is being explored clinically. Such laparoscopic procedures are technically challenging and require an experienced laparoscopic surgeon due to the lack of port placement triangulation and instrument clashing. Methods In the last years several surgeons all over the world have explored the feasibility and safety of LESS using several and different ports, approaches and devices. Hundereds of procedures have been described with overall favorauble intraoperative and postoperative outcomes. Results Our experience consists of more than 30 procedures successifully completed for adrenal, kidney disease and varicocele. Conclusions To date, LESS could be considered feasible and effective using currently available devices, however it is to be considered as an initial status technique requiring further confirmatory studies and advanced laparoscopic skills.
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Affiliation(s)
- F. Neri
- UOC Urologia Ospedale “San Pio da Pietrelcina” Vasto (CH)
| | - L. Cindolo
- UOC Urologia Ospedale “San Pio da Pietrelcina” Vasto (CH)
| | - S. Gidaro
- Dipartimento di Chirurgia e Scienze Sperimentali, Università di Chieti-Pescara
| | - L. Schips
- UOC Urologia Ospedale “San Pio da Pietrelcina” Vasto (CH)
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86
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Abstract
Laparoscopic surgery performed through a single-incision is gaining popularity. The demand from the public for even less invasive procedures will motivate surgeons, industry, and academic centers to explore the possibilities and refine the technology. Although the idea seems quite attractive, there are several technological obstacles that are yet to be conquered by improved technology or additional training. The question of safety has yet to be answered and will require well-designed randomized control trials. Opponents to the approach argue that the size of the single incision (see Table 1) is frequently larger than all the standard laparoscopy incisions combined. On the other hand, proponents remember a similar argument from traditional open surgeons during the initial development of laparoscopy. That argument was quickly discredited when the immediate benefits oflaparoscopy were compared with patients undergoing surgery with small laparotomy incisions. During the development of a new technique, the learning curve exposes patients to risk and society to expense. LESS pioneers appear to have reached a level of comfort with technology and techniques that paves the way for scientific scrutiny. Perhaps, the surgical community will capitalize on this situation with randomized, controlled studies and sound evidence to support or refute the benefits of LESS. If we do not seize this opportunity, patient demand and industry's dual edge message of financial success versus fear of losing referrals will lead to a scenario similar to the development of laparoscopic cholecystectomy in the 1990s. Regardless of its future, the surgical community will still benefit from a renewed excitement as surgeons aim to continually reduce the amount of pain and trauma our patients must endure. In addition, technological advances on instrumentation will benefit the field of laparoscopy and improve patient care.
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Affiliation(s)
- Anthony Y Tsai
- General Surgery Residency, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive #203, Indianapolis, IN 46202, USA.
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87
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Chamberlain RS, Sakpal SV. A comprehensive review of single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) techniques for cholecystectomy. J Gastrointest Surg 2009; 13:1733-40. [PMID: 19412642 DOI: 10.1007/s11605-009-0902-y] [Citation(s) in RCA: 200] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 04/15/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Surgery of the gallbladder has evolved tremendously over the last century. Laparoscopic cholecystectomy is the gold standard for gallbladder removal and the most common laparoscopic procedure worldwide. In recent times, innovative techniques of natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS) have been applied in gallbladder removal as a step towards even more less-invasive procedures. DISCUSSION While NOTES and SILS represent the advent of essentially scarless surgery, limited applications of these technologies in human subjects exists. In this article, we present a comprehensive review of the potential benefits, limitations and risks of these novel techniques. CONCLUSION While much remains unknown and unanswered surrounding these procedures, it is clear that extensive research and development with regards to the ethics and the technical aspects of these procedures as well as randomized studies to compare them with traditional laparoscopy are essential.
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88
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Abstract
Laparoendoscopic single site (LESS) surgery is a recently coined term that refers to a group of techniques that perform laparoscopic intervention through a single abdominal incision often hidden within the umbilicus. The relative ease and swiftness of early success of LESS surgery is in large part because of the familiarity of current practitioners with advanced laparoscopic techniques and the advent of several technologic advances in the areas of instrumentation, camera systems, and access devices. As ongoing advancements in instrumentation and future robotics platforms are incorporated, the scope and application of LESS surgery is likely to expand. Ultimately, prospective studies that compare the safety and effectiveness of this new approach with the standard conventional laparoscopic approach will determine the future role in surgical practice.
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89
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Cindolo L, Gidaro S, Tamburro FR, Schips L. Laparo-endoscopic single-site left transperitoneal adrenalectomy. Eur Urol 2009; 57:911-4. [PMID: 19608330 DOI: 10.1016/j.eururo.2009.07.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 07/01/2009] [Indexed: 12/14/2022]
Abstract
A 53-yr-old woman presented with abdominal pain. Ultrasonography, computed tomography, and an endocrinologic work-up revealed a 4-cm nonfunctional left adrenal mass. A TriPort laparoscopic adrenalectomy was performed. The TriPort was inserted through a 3-cm subcostal incision. Using 5-mm instruments, a left adrenalectomy was performed. The specimen was dissected (harmonic scalpel) and extracted through a 10-mm bag. A TriPort adrenalectomy was successfully completed in 240 min (blood loss: 20 ml). The postoperative period was uneventful (discharge within 3 d). In our opinion, the TriPort adrenalectomy is feasible and safe, with favourable perioperative and short-term outcomes and a delighted patient at the 8-mo follow-up.
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Affiliation(s)
- Luca Cindolo
- Urology Unit, "S. Pio da Pietrelcina" Hospital, Vasto (CH), Italy.
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90
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Rane A, Ahmed S, Kommu SS, Anderson CJ, Rimington PD. Single-port ‘scarless’ laparoscopic nephrectomies: the United Kingdom experience. BJU Int 2009; 104:230-3. [DOI: 10.1111/j.1464-410x.2009.08399.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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91
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Abstract
PURPOSE Single-incision laparoscopy is being performed for a wide variety of procedures. We describe our technique of single-incision laparoscopic right hemicolectomy for a colon mass. METHODS The dissection was performed in a medial-to-lateral fashion with intracorporeal anastomosis. RESULTS The length of stay was three days, and there were no postoperative complications. CONCLUSIONS Single-incision laparoscopic colectomy with an intracorporeal anastomosis can provide satisfactory oncologic resection.
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92
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Tracy CR, Raman JD, Cadeddu JA, Rane A. Laparoendoscopic single-site surgery in urology: where have we been and where are we heading? ACTA ACUST UNITED AC 2009; 5:561-8. [PMID: 18836465 DOI: 10.1038/ncpuro1215] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2008] [Accepted: 08/20/2008] [Indexed: 01/06/2023]
Abstract
One-port, single-incision laparoscopy is part of the natural development of minimally invasive surgery. Refinement and modification of laparoscopic instrumentation has resulted in a substantial increase in the use of laparoendoscopic single-site surgery (LESS) in urology over the past 2 years. Since the initial report of single-port nephrectomy in 2007, urologists have successfully performed various procedures with LESS, including partial nephrectomy, pyeloplasty, orchiectomy, orchiopexy, ureterolithotomy, sacrocolpopexy, renal biopsy, renal cryotherapy, and adrenalectomy. Further advancements in technology, such as magnetic anchoring and guidance systems, and robotic instrumentation, may allow broader application of this emerging surgical technique. Future research is required to determine the intraoperative and postoperative benefits of LESS in comparison with standard laparoscopy.
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Affiliation(s)
- Chad R Tracy
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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93
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Filipovic-Cugura J, Kirac I, Kulis T, Jankovic J, Bekavac-Beslin M. Single-incision laparoscopic surgery (SILS) for totally extraperitoneal (TEP) inguinal hernia repair: first case. Surg Endosc 2009; 23:920-1. [PMID: 19172350 DOI: 10.1007/s00464-008-0318-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 12/16/2008] [Indexed: 01/05/2023]
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94
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Transumbilical Gelport access technique for performing single incision laparoscopic surgery (SILS). J Gastrointest Surg 2009; 13:159-62. [PMID: 18972166 DOI: 10.1007/s11605-008-0737-y] [Citation(s) in RCA: 172] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 10/14/2008] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Single incision laparoscopic surgery (SILS) is an area of active research within general surgery. DISCUSSION A number of procedures, including cholecystectomy, appendectomy, urologic procedures, adrenalectomy, and bariatric procedures, are currently being performed with this methodology. There is, as yet, no standard published technique for single-port access to the peritoneal cavity for SILS. We describe, herein, an access technique utilizing existing instrumentation including a Gelport and wound retractor that is reliable and easy. This technique has been used successfully at our institution for a number of single incision laparoscopic procedures.
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95
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Castillo O, Sánchez-Salas R. Which patients are suitable candidates for laparoscopic adrenalectomy with needlescopic instruments? NATURE CLINICAL PRACTICE. UROLOGY 2009; 6:10-11. [PMID: 19048004 DOI: 10.1038/ncpuro1266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 11/10/2008] [Indexed: 05/27/2023]
Abstract
Laparoscopic adrenalectomy has become the standard surgical procedure for benign adrenal tumors. The benefits of this type of surgery are reduced blood loss and postoperative pain, improved cosmetic outcomes and a reduced hospital stay. All these features could potentially be improved further by use of needlescopic instruments, which have diameters < or =3 mm, in contrast to the 5-12 mm diameters of standard laparoscopic instruments. Liao and colleagues have presented comprehensive and objective results for laparoscopic adrenalectomy with needlescopic instruments (LANI) performed in 112 patients with presumptively benign adrenal tumors <5 cm in diameter. Their results provide evidence to support the use of LANI in this setting and show that the technique is feasible for surgeons who have extensive experience in performing laparoscopic surgery. Prospective comparisons of LANI with traditional laparoscopic adrenalectomy are awaited.
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Affiliation(s)
- Octavio Castillo
- Department of Urology at Clínica Indisa and University of Chile, Santiago, Chile.
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96
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Pohl PP, Meyer A, Lammers BJ, Goretzki PE. [Abdominal preoperation. No contraindication for laparoscopic transabdominal adrenalectomy]. Chirurg 2008; 79:571-5. [PMID: 17879074 DOI: 10.1007/s00104-007-1400-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Benign adrenal gland tumors smaller than 6 cm are nowadays the indication for minimally invasive surgery. Until now there has been no significant difference between retroperitoneoscopic and transabdominal adrenalectomy. Intestinal adhesions could be a contraindication against transabdominal laparoscopic adrenalectomy, and therefore the retroperitoneoscopic approach could be an advantage in these cases. A prospective study concerning this question has not been published yet. Our clinical investigation here includes 114 adrenalectomies during the last 5 years. We show that in any case of abdominal preoperation, laparoscopic adrenalectomy can be performed by transabdominal approach and without conversion to open surgery. Discussed are the different indications for laparoscopic adrenalectomy, operating time, conversion rate to open surgery, and amount and type of abdominal preoperation. We compared patients with and without abdominal preoperations.
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Affiliation(s)
- P P Pohl
- Klinik für Allgemein-, Visceral-, Gefäss- und Thoraxchirurgie, Städtische Kliniken Neuss,Lukaskrankenhaus-GmbH, Preussenstrasse 84, 41464, Neuss, Deutschland.
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97
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Castellucci SA, Curcillo PG, Ginsberg PC, Saba SC, Jaffe JS, Harmon JD. Single port access adrenalectomy. J Endourol 2008; 22:1573-6. [PMID: 18681804 DOI: 10.1089/end.2008.0100] [Citation(s) in RCA: 151] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To report the first single port access (SPA) adrenalectomy to minimize patient discomfort through a less invasive procedure. METHODS/RESULTS We performed the first SPA in a 63-year-old, otherwise healthy Caucasian female who had a 4.5-cm left adrenal mass that was incidentally discovered on computed tomography scan of the abdomen and pelvis. Through a 2-cm single longitudinal supraumbilical incision extended down to the abdominal fascia, three 5-mm ports were placed through separate facial entry points, to make a triangular port arrangement. The adrenal vein was identified and ligated using hemoclips. The remainder of the dissection was done using hemocoagulation. The adrenal gland was extracted via an EndoCatch bag device by removing one 5-mm port and upsizing to a 12-mm port. CONCLUSION We report on the first SPA adrenalectomy. Although this technology is still in its infancy, the use of a single port for surgery provides a means to provide a potentially better patient outcome with a less invasive procedure.
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Affiliation(s)
- Sean A Castellucci
- Hahnemann University Hospital, Drexel University, Philadelphia, Pennsylvania 19102, USA.
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98
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Kommu SS, Sooriakumaran P, Eden CG, Rané A. MINIMAL ACCESS MINIMALLY INVASIVE UROLOGICAL SURGERY - THE NEW PARADIGM. BJU Int 2008; 102:921-2. [DOI: 10.1111/j.1464-410x.2008.07918.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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99
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Walz MK, Alesina PF. Single access retroperitoneoscopic adrenalectomy (SARA)--one step beyond in endocrine surgery. Langenbecks Arch Surg 2008; 394:447-50. [PMID: 18784938 DOI: 10.1007/s00423-008-0418-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Accepted: 08/26/2008] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Today, endoscopic adrenalectomy has become a gold standard in endocrine surgery. METHOD AND RESULTS To minimize the morbidity and improve cosmesis, a single access retroperitoneoscopic adrenalectomy (SARA) has been developed. Patients were placed in prone position. Through a single 1.5 cm skin incision at the tip of the 12th rib the creation of the retroperitoneal space and the dissection of the adrenal gland were performed. SARA was used in five patients with adrenal tumors (size: 1-4 cm; four right, one left). Operating time ranged from 35 to 70 min, mean blood loss was <10 ml. No perioperative or postoperative complications were noticed. Mean hospital stay was 2 days. CONCLUSIONS SARA is feasible and represents a new horizon in endocrine surgery.
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Affiliation(s)
- Martin K Walz
- Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Henricistrasse 92, 45136, Essen, Germany.
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Sooriakumaran P, Kommu SS, Rane A. NOTES, SILS and OPUS: battle of the acronyms for the future of laparoscopic urology. Int J Clin Pract 2008; 62:988. [PMID: 18564272 DOI: 10.1111/j.1742-1241.2008.01787.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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