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Marchand GJ, Massoud A, Ulibarri H, Arroyo A, Herrera DG, Hamilton B, Ruffley K, Robinson M, Dominick M, Azadi A. Noninferiority of single-incision laparoscopy vs conventional laparoscopy in salpingectomy or salpingotomy for ectopic pregnancy: a meta-analysis. AJOG GLOBAL REPORTS 2025; 5:100435. [PMID: 39877551 PMCID: PMC11773238 DOI: 10.1016/j.xagr.2024.100435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2025] Open
Abstract
OBJECTIVE Ectopic pregnancy is an emergency frequently requiring laparoscopic intervention. This study aimed to determine whether single-incision laparoscopic surgery is a safe and effective treatment method compared with conventional laparoscopic surgery with multiple ports. DATA SOURCES This study searched 6 databases from their inception to May 15, 2024, for articles comparing the safety outcomes of single-incision laparoscopic surgery with conventional laparoscopic surgery in managing women with ectopic pregnancy. STUDY ELIGIBILITY CRITERIA This study included all studies that evaluated the safety outcomes of single-incision laparoscopic surgery compared with conventional laparoscopic surgery in patients with ectopic pregnancy and included at least 1 of our preselected outcomes. In addition, this study included both randomized controlled trials and observational studies. METHODS Review Manager (version 5.4.1) and OpenMetaAnalyst software were used to analyze the extracted data. In addition, this study used odds ratios for dichotomous outcomes, mean difference for continuous outcomes, a fixed effects model for homogeneous outcomes, and a random effects model for heterogeneous outcomes. Furthermore, heterogeneity was evaluated using the I2 and P values. After removing duplicates, this study identified 83 studies. Using a 2-step screening process, this study excluded non-English and animal studies and included randomized controlled trials and observational studies that included at least 1 of our preselected outcomes. Ultimately, 12 studies were included in the final synthesis. RESULTS Our analysis showed a significant favoring of the single-incision laparoscopic surgery group in the pain visual analog scale score (median difference=-0.57; P<.01). However, our study found no statistically significant difference between both procedures in the times of analgesic use (median difference=-0.08; P=.19), intraoperative complications (odds ratio=1.17; P=.8), postoperative complications (odds ratio=1.02; P=.96), conversion to laparotomy (odds ratio=1.40; P=.59), bowel injury (odds ratio=1.42; P=.8), and postoperative fever (odds ratio=0.52; P=.42). CONCLUSION The use of single-incision laparoscopic surgery for treating ectopic pregnancy may reduce postoperative pain with similar rates of analgesic use. The incidences of intraoperative and postoperative complications were comparable. Furthermore, the rates of conversion to laparotomy, bowel injury, and postoperative fever were similar between the 2 techniques. Our results seem to show that single-incision laparoscopic surgery is noninferior to conventional laparoscopic surgery for the safe treatment of ectopic pregnancy.
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Affiliation(s)
- Greg J. Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Marchand, Massoud, Ulibarri, Arroyo, Herrera, Hamilton, Ruffley, and Robinson)
| | - Ahmed Massoud
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Marchand, Massoud, Ulibarri, Arroyo, Herrera, Hamilton, Ruffley, and Robinson)
- Faculty of Medicine, Fayoum University, Faiyum, Egypt (Massoud)
| | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Marchand, Massoud, Ulibarri, Arroyo, Herrera, Hamilton, Ruffley, and Robinson)
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Marchand, Massoud, Ulibarri, Arroyo, Herrera, Hamilton, Ruffley, and Robinson)
| | - Daniela Gonzalez Herrera
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Marchand, Massoud, Ulibarri, Arroyo, Herrera, Hamilton, Ruffley, and Robinson)
| | - Brooke Hamilton
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Marchand, Massoud, Ulibarri, Arroyo, Herrera, Hamilton, Ruffley, and Robinson)
| | - Kate Ruffley
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Marchand, Massoud, Ulibarri, Arroyo, Herrera, Hamilton, Ruffley, and Robinson)
| | - Mckenna Robinson
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Marchand, Massoud, Ulibarri, Arroyo, Herrera, Hamilton, Ruffley, and Robinson)
| | - Marissa Dominick
- Midwestern University Chicago College of Osteopathic Medicine, Glendale, AZ (Dominick)
| | - Ali Azadi
- College of Medicine, University of Arizona, Phoenix, AZ (Azadi)
- School of Medicine, Creighton University, Phoenix, AZ (Azadi)
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Muacevic A, Adler JR, Pajai S, Mohammad S. Laparoendoscopic Single-Site Surgery (LESS): A Shift in Gynecological Minimally Invasive Surgery. Cureus 2022; 14:e32205. [PMID: 36620796 PMCID: PMC9813544 DOI: 10.7759/cureus.32205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Laparotomy was once the preferred modality of treatment for various gynecological conditions. However, over the years, with the advancements worldwide, a new technique for surgery, laparoscopy, came into play. Since then, laparoscopy is preferred over laparotomy for diagnostic and therapeutic purposes since it was less invasive than laparotomy. Further advancements include laparoendoscopic single-site surgery (LESS), which is a procedure that, as the name implies, only uses one port. It includes using a single incision near the umbilicus in contrast to laparoscopy, which traditionally includes one main port incision and various other side ports. Through the port, multiple devices can be inserted into the cavity. The use of a single port can reduce post-operative complications and help reduce the duration of hospital stays. A single incision near the umbilicus would not leave a very significant scar, and the wound healing time would be comparatively less, reducing the hospital stay time. This novel technique is, therefore, an amalgamation of traditional surgery and recently surfacing minimally invasive surgery. Other modalities which are being used widely include vaginal natural orifice transluminal endoscopic surgery (vNOTES). Since the ports formed are frequently inconspicuous, these procedures leave patients with "scarless" results.
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Prassas D, Rolfs TM, Vaghiri S, Kounnamas A, Knoefel WT, Krieg A. Single-port versus multi-port totally extraperitoneal (TEP) inguinal hernia repair: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2022; 101:e30820. [PMID: 36397342 PMCID: PMC10662824 DOI: 10.1097/md.0000000000030820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/30/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The value of single-port totally extraperitoneal inguinal hernia repair (STEP) when compared to the conventional multi-port approach (TEP) is still a matter of controversy. We conducted a meta-analysis of randomized controlled trials comparing the feasibility and safety of the above-mentioned techniques. METHODS A systematic literature search for randomized controlled trials (RCTs) comparing the outcome STEP and TEP in patients with inguinal hernia was conducted. Data regarding postoperative outcomes were extracted and compared by meta-analysis. The Odds Ratio and Standardized Mean Differences with 95% Confidence Intervals (CI) were calculated. RESULTS Six RCTs were identified, involving a total of 636 cases (STEP: n = 328, TEP: n = 308). There was a statistically significant difference noted between the 2 groups regarding return to everyday activities favoring the STEP group (SMD = -0.23; 95% CI [-0.41, -0.06]; P = .01; 4 studies; I2 = 9). For the remaining primary and secondary endpoints, intra- and postoperative morbidity, conversion rate, peritoneal tears, major intraoperative bleeding, postoperative haematoseroma, operative time, postoperative pain, chronic pain, cosmetic satisfaction, hernia recurrence and in-hospital length of stay no statistically significant difference was noted between the 2 study groups. CONCLUSIONS Current evidence suggests that patients who underwent STEP had similar outcomes to the traditional TEP technique with the exception of time to return to everyday activities, which was reported to be shorter in the STEP group.
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Affiliation(s)
- Dimitrios Prassas
- Heinrich-Heine-University and University Hospital Duesseldorf, Department of Surgery, Duesseldorf, Germany
| | - Thomas Marten Rolfs
- Catholic Hospital Essen Philippusstift, Teaching Hospital of Duisburg-Essen University, Department of Surgery, Essen, Germany
| | - Sascha Vaghiri
- Heinrich-Heine-University and University Hospital Duesseldorf, Department of Surgery, Duesseldorf, Germany
| | - Aristodemos Kounnamas
- Heinrich-Heine-University and University Hospital Duesseldorf, Department of Surgery, Duesseldorf, Germany
| | - Wolfram Trudo Knoefel
- Heinrich-Heine-University and University Hospital Duesseldorf, Department of Surgery, Duesseldorf, Germany
| | - Andreas Krieg
- Heinrich-Heine-University and University Hospital Duesseldorf, Department of Surgery, Duesseldorf, Germany
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Oncologic outcomes of single-incision laparoscopic surgery versus conventional laparoscopic surgery for colorectal cancer (CSILS): study protocol for a multicentre, prospective, open-label, noninferiority, randomized controlled trial. BMC Cancer 2022; 22:743. [PMID: 35799145 PMCID: PMC9264567 DOI: 10.1186/s12885-022-09821-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/24/2022] [Indexed: 12/24/2022] Open
Abstract
Background In most previous studies, single-incision laparoscopic surgery (SILS) for colorectal cancer (CRC) was feasible and safe in the short term. However, long-term oncologic outcomes remain uncertain, as only a few studies contained long-term survival data. SILS for CRC is still in the early stages of research. Further studies, particularly large-scale, prospective randomized controlled trials, are necessary to assess the value of SILS for CRC. Methods This study is a prospective, multicentre, open-label, noninferiority, parallel-group randomized controlled trial that investigates the long-term oncologic outcomes of SILS compared to conventional laparoscopic surgery (CLS) for CRC. A total of 710 eligible patients will be randomly assigned to the SILS group or the CLS group at a 1:1 ratio using a central, dynamic, and stratified block randomization method. Patients with ages ranging from 18 to 85 years old, of both sexes, with CRC above the peritoneal reflection diagnosed as cT1-4aN0-2M0 and a tumour size no larger than 5 cm will be considered for the study. The primary endpoint is 3-year disease-free survival (DFS). The secondary endpoints include: intraoperative outcomes, postoperative recovery, postoperative pain assessment, pathological outcomes, early morbidity and mortality rate, cosmetic effects, quality of life, 3-year overall survival (OS), incidence of incisional hernia, 5-year DFS and 5-year OS. The first two follow-up visits will be scheduled at one month and three months postoperatively, then every three months for the first two years and every six months for the next three years. Discussion Currently, no randomized controlled trials (RCTs) have been designed to investigate the long-term oncologic outcomes of SILS for CRC. This study is expected to provide clinical evidence of the oncologic outcomes of SILS compared to CLS for CRC to promote its widespread use. Trial registration ClinicalTrials.gov: NCT 04527861 (registered on August 27, 2020).
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Tewari S, Chambers LM, Yao M, Michener CM. Evaluation of Closure Technique on Incidence of Incisional Hernia Following Single Port Laparoscopy in Gynecologic Oncology Surgery. J Minim Invasive Gynecol 2022; 29:791-802.e1. [PMID: 35331927 DOI: 10.1016/j.jmig.2022.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To evaluate incidence and risk factors for incisional hernia in women undergoing single-port laparoscopy (SPL) for gynecologic oncology indications with a standardized fascia closure (SC) technique versus historical controls (HC). DESIGN Retrospective cohort study. SETTING Single academic institution. PATIENTS Women who underwent SPL from 6/1/2017-12/31/2019 for gynecologic oncology indications with SC were compared to HC who underwent SPL from 1/1/2009-12/31/2015. INTERVENTIONS Data was collected for patient demographics, postoperative outcomes, and incisional hernia development. Univariate analysis and multivariable regression models were built for predictors of incisional hernia. MEASUREMENTS AND MAIN RESULTS Of 1,163 patients, 242 (20.8%) patients had SC and 921 (79.2%) patients had HC. SC cohort had lower rates of diabetes versus HC (10.3% vs. 15.3%; p = .049) but no differences in hypertension (36.8% vs. 43.0% p = .081) and obesity (42.6% vs. 36.9%, p = .11). 1,123 (96.6%) patients did not undergo conversion to multi-port laparoscopy or laparotomy, of whom 7.2% (n=81) of patients developed an incisional hernia; there was no difference in incisional hernia development for SC with SPL (n= 237) versus HC with SPL (n= 886) (9.7% vs. 6.5%, p = .095). On multivariable analysis, increased BMI (OR 1.06; 95% CI 1.03-1.09, p < .001) and diabetes (OR 2.41; CI 1.34-4.32, p = .003) were associated with incisional hernia, but age (OR 1.00; CI .98-1.02, p = .92), length of surgery (OR 1.00; CI 1.00-1.01, p = .62), and hypertension (OR .89; CI .52-1.53, p = .68) were not. Patients with prior abdominal surgeries (OR 1.92; CI 1.14-3.26, p = .015) and hand-assist surgery (OR 3.17; CI 1.48-6.80, p = .003) were significantly associated with incisional hernia. CONCLUSION Implementation of a SC protocol did not decrease rate of incisional hernia versus HC during SPL. Risk of incisional hernia must be considered for SPL planning in patients with complex medical comorbidities and prior abdominal surgery.
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Affiliation(s)
- Surabhi Tewari
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Laura M Chambers
- Division of Gynecologic Oncology, The Ohio State James Cancer Center. The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Meng Yao
- Department of Qualitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Chad M Michener
- Division of Gynecologic Oncology, Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.
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Lyu Y, Cheng Y, Wang B, Zhao S, Chen L. Single-incision versus conventional multiport laparoscopic cholecystectomy: a current meta-analysis of randomized controlled trials. Surg Endosc 2020; 34:4315-4329. [PMID: 31620914 DOI: 10.1007/s00464-019-07198-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND We performed this study to compare the safety and feasibility of single-incision laparoscopic cholecystectomy (SILC) with conventional multiple-port laparoscopic cholecystectomy (MPLC). METHODS We searched PubMed, Embase, Web of Science, the Cochrane Controlled Register of Trials (CENTRAL), and ClinicalTrials.gov for randomized controlled trials comparing SILC versus MPLC. We evaluated the pooled outcomes for complications, pain scores, and surgery-related events. This study was performed in accordance with PRISMA guidelines. RESULTS A total of 48 randomized controlled trials involving 2838 patients in the SILC group and 2956 patients in the MPLC group were included in this study. Our results showed that SILC was associated with a higher incidence of incisional hernia (relative risk = 2.51; 95% confidence interval = 1.23-5.12; p = 0.01) and longer operation time (mean difference = 15.27 min; 95% confidence interval = 9.67-20.87; p < 0.00001). There were no significant differences between SILC and MPLC regarding bile duct injury, bile leakage, wound infection, conversion to open surgery, retained common bile duct stones, total complication rate, and estimated blood loss. No difference was observed in postoperative pain assessed by a visual analogue scale between the two groups at four time points (6 h, 8 h, 12 h, and 24 h postprocedure). CONCLUSIONS Based on the current evidence, SILC did not result in better outcomes compared with MPLC and both were equivalent regarding complications. Considering the additional surgical technology and longer operation time, SILC should be chosen with careful consideration.
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Affiliation(s)
- Yunxiao Lyu
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, 60 West Wuning Road, Dongyang, 322100, Zhejiang, China.
- Department of General Surgery, Dongyang People's Hospital, 60 West Wuning Road, 322100, Dongyang, Zhejiang, China.
| | - Yunxiao Cheng
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, 60 West Wuning Road, Dongyang, 322100, Zhejiang, China
| | - Bin Wang
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, 60 West Wuning Road, Dongyang, 322100, Zhejiang, China
| | - Sicong Zhao
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, 60 West Wuning Road, Dongyang, 322100, Zhejiang, China
| | - Liang Chen
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, 60 West Wuning Road, Dongyang, 322100, Zhejiang, China
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Delgado-Sánchez E, Peay-Pinacho JA, Hernández Gutiérrez A, Álvarez Bernardi J, Zapardiel I. Role of single-site and mini-laparoscopy in gynecologic surgery. Minerva Obstet Gynecol 2020; 73:166-178. [PMID: 32677777 DOI: 10.23736/s2724-606x.20.04607-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Laparoscopy is a surgical procedure that has been used widely in medicine over the last thirty years. In gynecology, laparoscopy is the "gold standard" for the majority of gynecological procedures, as its superiority over laparotomy has been widely demonstrated. In recent years, the current trend of gynecologists is to make laparoscopy surgery even less invasive by reducing the number of incisions in the skin, as it happens with laparoendoscopic single-site surgery, or by reducing the size of them as in mini-laparoscopy. The aim of this work was to perform an extensive review and update of the evolution of single-port surgery and mini-laparoscopic surgery in gynecology as well as to evaluate its current role in this field. EVIDENCE ACQUISITION A systematic review was performed during April and May 2020. PRISMA guidelines were followed for the literature search. EVIDENCE SYNTHESIS The main objective of performing less invasive procedures is to reduce both intraoperative complications (decreased risk of bleeding or damage to internal organs), and postoperative ones (hernias through the trocar) and improve cosmetic results. Results of studies about LESS and mini-LPS showed encouraging results, being both of them safe with a similar perioperative and postoperative outcome. They have the approval of the international surgical community as well as patients' satisfaction with cosmetic results. CONCLUSIONS Minimally invasive surgery is the present and future in gynecological surgery. More prospective randomized trials are needed in order to obtain valid results and affirm that both LESS and Mini-LPS are superior to conventional laparoscopy.
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Affiliation(s)
- Elsa Delgado-Sánchez
- Department of Gynecology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Spain
| | - John A Peay-Pinacho
- Department of Gynecology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Spain
| | | | - Julio Álvarez Bernardi
- Department of Gynecology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Spain
| | - Ignacio Zapardiel
- Unit of Gynecologic Oncology, La Paz University Hospital (IdiPAZ), Madrid, Spain -
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Feasibility of Single-Port Cholecystectomy With Wound Retractor and a Glove in a Rural Hospital in Mexico. Int Surg 2018. [DOI: 10.9738/intsurg-d-15-00061.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Laparoscopic surgery has been established as the standard therapy for symptomatic cholecystolithiasis. Now, single-port cholecystectomy is a surgical option. Due to the need of special laparoscopic instruments and devices, the cost of the surgery is significantly increased, limiting its popularity in most medical centers in developing countries, especially in rural areas. This paper's objective was to show the safety, reproducibility, and feasibility of single-port laparoscopic cholecystectomy using conventional laparoscopic equipment, a wound retractor, and a sterile glove in a rural hospital in Mexico. A prospective study was carried out from July to October 2014. Patients diagnosed with uncomplicated cholecystolithiasis who agreed to participate were operated with this technique. Complications, operative time, bleeding, evolution, and length of hospital stay were recorded. A total of 24 women went onto surgery under this approach. A mean follow-up of 71 days was completed. No incisional hernias, bile duct injuries, wound infection, nor death was presented. Surgical time and cost were not significantly increased compared to conventional laparoscopic approach. Most patient discharge was done the same day of the surgery. Single-port laparoscopic cholecystectomy is a cost-effective procedure, which can be performed in all hospitals where an Alexis retractor and conventional laparoscopic equipment is available. There was no increase of surgical morbidity. The single-port cholecystectomy is a technically feasible and safe surgical option in selected patients and can be easily performed in rural hospitals at a low cost, providing the benefits of the single incision.
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Minilaparoscopic versus single incision cholecystectomy for the treatment of cholecystolithiasis: a meta-analysis and systematic review. BMC Surg 2017; 17:91. [PMID: 28830403 PMCID: PMC5568361 DOI: 10.1186/s12893-017-0287-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 08/13/2017] [Indexed: 01/11/2023] Open
Abstract
Background Over the past decade, mini-laparoscopic cholecystectomy (MLC) and single-port laparoscopic cholecystectomy (SILC) have been the two main successful mini-invasive surgical interventions for the treatment of cholecystolithiasis since the advent of laparoscopic cholecystectomy (LC). In this study, we conducted a meta-analysis to compare the two treatment alternatives. Methods We searched PubMed, CNKI and the Cochrane library for trials that compared MLC and SILC. Risk difference (RD) and mean difference (MD) were calculated with a 95% confidence interval (CI). Results Four randomized controlled trials (RCTs) and 2 non-randomized comparative studies (nRCSs) involving 2764 patients were identified. A longer operating time (MD -10.49; 95% CI -18.10, −2.88; P = 0.007) and a shorter wound length (MD 3.65; 95% CI 0.51, 6.78; P = 0.02) were found to be associated with SILC compared with MLC. No significant differences were revealed in conversion, hospital stay, pain relief and cosmetic results. Although a lower incidence of complications was observed with MLC (8.2%) compared with SILC (15.9%), but the difference was not statistically significant (RD -0.06; 95% CI -0.12, 0.00; P = 0.07). Conclusions MLC has an advantage over SILC in terms of operating time rather than hospital stay, pain relief, cosmetic results. Though conversion and complication rates were higher with SILC, there existed no statistically differences in the two measures between the two procedures. Whether MLC confers any benefits in terms of conversion or complications still warrants further studies. Electronic supplementary material The online version of this article (doi:10.1186/s12893-017-0287-x) contains supplementary material, which is available to authorized users.
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Chow G, Chiu CJ, Zheng B, Panton ON, Meneghetti AT. Rigid vs articulating instrumentation for task completion in single-port surgery. Am J Surg 2016; 211:903-7. [PMID: 27083064 DOI: 10.1016/j.amjsurg.2016.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/18/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Single-port access surgery (SPA) may provide benefits but there is a steep learning curve. We compare traditional in-line instruments with articulating instruments. METHODS Fundamentals of laparoscopic surgery peg transfer task was performed using a 3-port approach or SPA device. Standard rigid instrumentation was compared with articulating instrumentation. RESULTS Twenty surgeons completed all tasks. Average time using a conventional approach was shorter than SPA (144 ± 54 vs 198 ± 74 seconds, P < .001). Articulating instruments required longer procedural time than rigid instrumentation (201 ± 66 vs 141 ± 58 seconds, P < .001). In the conventional model, task time was lower with rigid instruments than with articulating instruments (108 vs 179 seconds, P < .001). Task time in the SPA model was lower with rigid instruments (173 vs 223 seconds, P =.013). CONCLUSIONS All tasks required longer time to complete in SPA when compared with a conventional approach. Articulating instruments have an increased benefit in SPA surgery.
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Affiliation(s)
- Geoffrey Chow
- Department of Surgery, Division of General Surgery, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Chieh Jack Chiu
- Department of Surgery, Division of General Surgery, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Bin Zheng
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Ormond Neely Panton
- Department of Surgery, Division of General Surgery, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Adam T Meneghetti
- Department of Surgery, Division of General Surgery, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada.
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Bedaiwy MA, Farghaly T, Hurd W, Liu J, Mansour G, Fader AN, Escobar P. Laparoendoscopic single-site surgery for management of ovarian endometriomas. JSLS 2016; 18:191-6. [PMID: 24960481 PMCID: PMC4035628 DOI: 10.4293/108680813x13794522666284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To compare our initial experience in laparoscopic surgery for ovarian endometriomas performed through an umbilical incision using a single 3-channel port and flexible laparoscopic instrumentation versus traditional laparoscopy. METHODS This study was conducted in 3 tertiary care referral centers. Since September 2009, we have performed laparoendoscopic single-site surgery in 24 patients diagnosed with ovarian endometriomas. A control group of patients with similar diagnoses who underwent traditional operative laparoscopy during the same period was included (n = 28). In the laparoendoscopic single-site surgery group, a multichannel port was inserted into the peritoneum through a 1.5- to 2.0-cm umbilical incision. RESULTS Patients in the laparoendoscopic single-site surgery group were significantly older (P = .04) and had a higher body mass index (P = .005). Both groups were comparable regarding history of abdominal surgery, lateral pelvic side wall involvement, and cul-de-sac involvement. After we controlled for age and body mass index, the size of the resected endometriomas, duration of surgery, and amount of operative blood loss were comparable in both groups. When required, an additional 5-mm port was inserted in the right or left lower quadrant in the laparoendoscopic single-site surgery group to allow the use of a third instrument for additional tissue retraction or manipulation (10 of 24 patients, 41.6%). However, adhesiolysis was performed more frequently in the conventional laparoscopy group. The duration of hospital stay was <24 hours in both groups. No intraoperative complications were encountered. All incisions healed and were cosmetically satisfactory. CONCLUSION The laparoendoscopic single-site surgery technique is a reasonable initial approach for the treatment of endometriomas. In our experience, an additional side port is usually needed to treat pelvic side wall and cul-de-sac endometriosis that often accompanies endometriomas.
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Affiliation(s)
- Mohamed A Bedaiwy
- University Hospitals Case Medical Center, Case Western Reserve University, OH, USA; Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia D415A4500 Oak Street Vancouver, BC V6H 3N1, Canada.
| | - Tarek Farghaly
- University Hospitals Case Medical Center, Case Western Reserve University, OH, USA
| | - William Hurd
- University Hospitals Case Medical Center, Case Western Reserve University, OH, USA
| | - James Liu
- University Hospitals Case Medical Center, Case Western Reserve University, OH, USA
| | - Gihan Mansour
- University Hospitals Case Medical Center, Case Western Reserve University, OH, USA
| | - Amanda Nickles Fader
- Department of Gynecology, Greater Baltimore Medical Center and Johns Hopkins Hospital, Baltimore, MD, USA
| | - Pedro Escobar
- Department of OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
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Kozlov Y, Novozhilov V, Baradieva P, Krasnov P, Kovalkov K, Muensterer OJ. Single-incision pediatric endosurgery in newborns and infants. World J Clin Pediatr 2015; 4:55-65. [PMID: 26566478 PMCID: PMC4637810 DOI: 10.5409/wjcp.v4.i4.55] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/22/2015] [Accepted: 10/19/2015] [Indexed: 02/06/2023] Open
Abstract
This study focuses on the successful application of single-incision pediatric endosurgery in the treatment of congenital anomalies and acquired diseases in neonates and infants. The purpose of this scientific review consists in highlighting the spectrum, indications, applicability, and effectiveness of single-port endosurgery in children during the first 3 postnatal months.
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Taşdemir N, Abalı R, Çelik C, Aksu E, Akkuş D. Single-incision-two port laparoscopic tubal ligation: A cost comparison and technique description. J Turk Ger Gynecol Assoc 2015; 16:30-1. [PMID: 25788846 DOI: 10.5152/jtgga.2015.15132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 12/18/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Laparoscopic surgery is the principal minimally invasive technique that is used for the treatment of gynecologic pathologies. The single-incision laparoscopic surgery (SILS) is another innovation in minimally invasive medicine. The cost of the procedure correlates with the fundamental materials used to access the abdominal cavity and utilize trocars. MATERIAL AND METHODS We applied the single-incision tubal ligation procedure to three patients. A 15-20-mm vertical incision was made in the umbilicus. Two trocars were inserted through the same incision at different fascial regions after insufflation of the abdomen. A 5-mm bipolar cautery was introduced through the accessory trocar, and the mid-portion of the tubes was coagulated and cut bilaterally. RESULTS The postoperative periods of the three patients were uneventful. All patients were discharged on the day of surgery. No major or minor complications occurred. CONCLUSION The cost for the abdominal access will drop about 82%. When we consider the low pricing for the tubal ligation procedure, the single-incision technique will be more applicable by this method. Moreover, patients will have the advantages of single-incision laparoscopic surgery with low cost.
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Affiliation(s)
- Nicel Taşdemir
- Department of Obstetrics and Gynecology, Namık Kemal University Faculty of Medicine, Tekirdağ, Turkey
| | - Remzi Abalı
- Department of Obstetrics and Gynecology, Namık Kemal University Faculty of Medicine, Tekirdağ, Turkey
| | - Cem Çelik
- Department of Obstetrics and Gynecology, Namık Kemal University Faculty of Medicine, Tekirdağ, Turkey
| | - Erson Aksu
- Department of Obstetrics and Gynecology, Namık Kemal University Faculty of Medicine, Tekirdağ, Turkey
| | - Didem Akkuş
- Department of Obstetrics and Gynecology, Namık Kemal University Faculty of Medicine, Tekirdağ, Turkey
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Kim MK, Kim JJ, Choi JS, Eom JM, Lee JH. Prospective comparison of single port versus conventional laparoscopic surgery for ectopic pregnancy. J Obstet Gynaecol Res 2014; 41:590-5. [DOI: 10.1111/jog.12595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 08/12/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Min Kyung Kim
- Department of Obstetrics and Gynecology; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jeong Jin Kim
- Department of Obstetrics and Gynecology; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Joong Sub Choi
- Department of Obstetrics and Gynecology; College of Medicine; Hanyang University; Seoul Korea
| | - Jeong Min Eom
- Department of Obstetrics and Gynecology; National Medical Center; Seoul Korea
| | - Jung Hun Lee
- Department of Obstetrics and Gynecology; MizMedi Hospital, Eulji University School of Medicine; Seoul Korea
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The real-world application of single incision laparoscopic cholecystectomy. Int J Surg 2014; 12:1254-7. [PMID: 25300738 DOI: 10.1016/j.ijsu.2014.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/06/2014] [Accepted: 09/18/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Most previous studies that have investigated single incision laparoscopic cholecystectomy (SILC) are case series with limited sample sizes. We have reviewed the outcome of 500 consecutive cases of SILC performed by a single surgeon at our center. MATERIALS AND METHODS From April 2009 to October 2012, a single surgeon performed 1250 laparoscopic cholecystectomies for various gallbladder (GB) diseases. SILC was chosen as the surgical modality unless there was evidence of acute cholecystitis or GB empyema, the patient had a prior history of upper abdominal surgery, endoscopic sphincterotomy, or had comorbidities with an ASA score of III or higher. The clinicopathologic features and perioperative data of patients were retrospectively reviewed. RESULTS The mean age and BMI of included patients were 42.7 years and 23.6 kg/m(2), respectively. The mean operating time was 52 min. Patients stayed in the hospital for an average of 1.3 days postoperatively. In 55 patients, an additional 2 mm trocar was inserted for retraction of the GB. One patient was converted to an open cholecystectomy because of Mirizzi syndrome. There were no observed complications including incisional hernias in this patient population. CONCLUSIONS SILC is a safe, effective procedure for cholecystectomy that may be considered the main surgical strategy in select patients.
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Two-port access versus four-port access laparoscopic ovarian cystectomy. Obstet Gynecol Sci 2014; 57:379-85. [PMID: 25264528 PMCID: PMC4175598 DOI: 10.5468/ogs.2014.57.5.379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 07/30/2013] [Accepted: 09/16/2013] [Indexed: 12/03/2022] Open
Abstract
Objective This study was conducted to compare the surgical outcomes between two-port access and four-port access laparoscopic ovarian cystectomy. Methods Four hundred and eighty nine patients who had received two-port access laparoscopic ovarian cystectomy (n=175) and four-port access laparoscopic ovarian cystectomy (n=314) in Chungnam National University Hospital from January 2009 to August 2012 were analyzed retrospectively. The data were compared between the bilaterality of the cysts and cyst diameter of less than 6 cm and 6 cm or more. Results There were no significant differences in patient's age, parity, body weight, body mass index and history of previous surgery between the two-port and four-port access laparoscopy group. Bilaterality of ovarian cysts was more in fourport access laparoscopy group (13.7% vs. 32.5%, P=0.000). There were no significant differences in operation time, hemoglobin change, hospital stay, adhesiolysis, transfusion, and insertion of hemo-vac between the two-port and four-port access laparoscopy group for size matched compare. However additional analgesics were more in four-port access laparoscopy group for unilateral ovarian cystectomy. Conclusion Two-port access laparoscopic surgery was feasible and safe for unilateral and bilateral ovarian cystectomy compare with four-port access laparoscopic surgery.
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Lee IO, Yoon JW, Chung D, Yim GW, Nam EJ, Kim S, Kim SW, Kim YT. A comparison of clinical and surgical outcomes between laparo-endoscopic single-site surgery and traditional multiport laparoscopic surgery for adnexal tumors. Obstet Gynecol Sci 2014; 57:386-92. [PMID: 25264529 PMCID: PMC4175599 DOI: 10.5468/ogs.2014.57.5.386] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/05/2014] [Accepted: 03/25/2014] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare clinical and surgical outcomes between laparo-endoscopic single-site (LESS) surgery and traditional multiport laparoscopic (TML) surgery for treatment of adnexal tumors. METHODS Medical records were reviewed for patients undergoing surgery for benign adnexal tumors between January 2008 and April 2012 at our institution. All procedures were performed by the same surgeon. Clinical and surgical outcomes for patients undergoing LESS surgery using Glove port were compared with those patients undergoing TML surgery. RESULTS A review of 129 patient cases undergoing LESS surgery using Glove port and 100 patient cases undergoing TML surgery revealed no significant differences in the baseline characteristics of the two groups. The median operative time was shorter in the LESS group using Glove port at 44 minutes (range, 19-126 minutes) than the TML group at 49 minutes (range, 20-196 minutes) (P=0.0007). There were no significant differences between in the duration of postoperative hospital stay, change in hemoglobin levels, pain score or the rate of complications between the LESS and TML groups. CONCLUSION LESS surgery showed comparable clinical and surgical outcomes to TML surgery, and required less operative time. Future prospective trials are warranted to further define the benefits of LESS surgery for adnexal tumor treatment.
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Affiliation(s)
- In Ok Lee
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Won Yoon
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - Dawn Chung
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - Ga Won Yim
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sunghoon Kim
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei University College of Medicine, Seoul, Korea
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Abstract
Surgery has changed dramatically over the last several decades. The emergence of MIS has allowed pediatric surgeons to manage critically ill neonates, children, and adolescents with improved outcomes in pain, postoperative course, cosmesis, and return to normal activity. Procedures that were once thought to be too difficult to attempt or even contraindicated in pediatric patients in many instances are now the standard of care. New and emerging techniques, such as single-incision laparoscopy, endoscopy-assisted surgery, robotic surgery, and techniques yet to be developed, all hold and reveal the potential for even further advancement in the management of these patients. The future of MIS in pediatrics is exciting; as long as our primary focus remains centered on developing techniques that limit morbidity and maximize positive outcomes for young patients and their families, the possibilities are both promising and infinite.
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Affiliation(s)
- Hope T Jackson
- Department of Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Timothy D Kane
- Department of Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Surgical Residency Training Program, Division of Pediatric Surgery, Department of Surgery, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, 111 Michigan Avenue, Northwest, Washington, DC 20010-2970, USA.
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Single-Port Access Laparoscopic Surgery in Gynecologic Oncology: Outcomes and Feasibility. Int J Gynecol Cancer 2014; 24:1126-32. [DOI: 10.1097/igc.0000000000000150] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectivesSingle-port access laparoscopic surgery (SPALS) is supposed to simplify and improve the outcomes of current multiport laparoscopic procedures. This retrospective study was performed to assess the actual outcomes of SPALS in 2 simple gynecological oncology procedures, namely, diagnostic laparoscopy and bilateral adnexectomy.MethodsWe conducted a retrospective monocentric study. Case files of only those women who underwent bilateral adnexectomies and diagnostic and/or staging laparoscopy were studied with respect to the operative room time, intraoperative and postoperative complications, postoperative pain, and lengths of hospital stays. The main objective was to assess the feasibility and utility of SPALS surgery in gynecology. The secondary objective was to compare this group with a cohort of patients with multiport conventional laparoscopic surgery (MPCLS) performed during the same period.ResultsFrom December 2009 to March 2013, there were 134 patients who underwent these 2 procedures. Eighty adnexectomies were performed, 41 by SPALS and 39 by MPCLS. Fifty-four diagnostic laparoscopies were performed, with 27 patients in each group. In the group of adnexectomies, operative time was significantly lower in SPALS compared with MPCLS (36 vs 59 minutes, P < 10−4) and also compared with the postoperative stay (1 vs 2.2 nights, P < 10−4). By contrast, no significant difference was observed between the 2 methods of access in all the parameters studied in the group of diagnostic laparoscopies.ConclusionsOur experience demonstrates that SPALS is feasible and safe for simple gynecological procedures. This approach may result in a smooth postoperative course and shorter hospital stay and can thus be promoted to a day care procedure.
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McCrory B, LaGrange CA, Hallbeck M. Quality and safety of minimally invasive surgery: past, present, and future. Biomed Eng Comput Biol 2014; 6:1-11. [PMID: 25288906 PMCID: PMC4147776 DOI: 10.4137/becb.s10967] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 03/17/2014] [Accepted: 03/18/2014] [Indexed: 12/14/2022] Open
Abstract
Adverse events because of medical errors are a leading cause of death in the United States (US) exceeding the mortality rates of motor vehicle accidents, breast cancer, and AIDS. Improvements can and should be made to reduce the rates of preventable surgical errors because they account for nearly half of all adverse events within hospitals. Although minimally invasive surgery (MIS) has proven patient benefits such as reduced postoperative pain and hospital stay, its operative environment imposes substantial physical and cognitive strain on the surgeon increasing the risk of error. To mitigate errors and protect patients, a multidisciplinary approach is needed to improve MIS. Clinical human factors, and biomedical engineering principles and methodologies can be used to develop and assess laparoscopic surgery instrumentation, practices, and procedures. First, the foundational understanding and the imperative to transform health care into a high-quality and safe system is discussed. Next, a generalized perspective is presented on the impact of the design and redesign of surgical technologies and processes on human performance. Finally, the future of this field and the research needed to further improve the quality and safety of MIS is discussed.
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Affiliation(s)
- Bernadette McCrory
- Mechanical and Materials Engineering Department, University of Nebraska, Lincoln, NE, USA
| | - Chad A LaGrange
- Division of Urologic Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ms Hallbeck
- Mechanical and Materials Engineering Department, University of Nebraska, Lincoln, NE, USA. ; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Health Care Policy and Research Department, Mayo Clinic, Rochester, MN, USA
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21
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Single-incision subxiphoid approach for bilateral metastasectomy. Ann Thorac Surg 2014; 97:718-9. [PMID: 24484826 DOI: 10.1016/j.athoracsur.2013.06.123] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/05/2013] [Accepted: 06/20/2013] [Indexed: 12/21/2022]
Abstract
We report a case of single-incision bilateral partial lung resection using the subxiphoid approach. This approach requires a 3-cm incision in the abdomen, making it aesthetically favorable. In addition, it does not cause postoperative intercostal neuropathy, and postoperative pain is minimal because the intercostal space is bypassed. Moreover, this technique enables exposure to both lungs through a single incision and has potential for widespread use if maneuverability can be increased by improving the instruments used.
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22
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Kim SJ, Choi BJ, Lee SC. Overview of single-port laparoscopic surgery for colorectal cancers: past, present, and the future. World J Gastroenterol 2014; 20:997-1004. [PMID: 24574772 PMCID: PMC3921551 DOI: 10.3748/wjg.v20.i4.997] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 11/01/2013] [Accepted: 12/05/2013] [Indexed: 02/07/2023] Open
Abstract
Single-port laparoscopic surgery (SPLS) is implemented through a tailored minimal single incision through which a number of laparoscopic instruments access. Introduction of operation-customized port system, utilization of a camera without a separate external light, and instruments with different lengths has brought the favorable environment for SPLS. However, performing SPLS still creates several hardships compared to multiport laparoscopic surgery; a single-port system inevitably leads to clashing of surgical instruments due to crowding. To overcome such difficulties, investigators has developed novel concepts and maneuvers, including the concept of inverse triangulation and the maneuvers of pivoting, spreading out dissection, hanging suture, and transluminal traction. The final destination of SPLS is expected to be a completely seamless operation, maximizing the minimal invasiveness. Specimen extraction through the umbilicus can undermine cosmesis by inducing a larger incision. Therefore, hybrid laparoscopic technique, which combined laparoscopic surgical technique with natural orifice specimen extraction (NOSE)--i.e., transvaginal or transanal route-, has been developed. SPLS and NOSE seemed to be the best combination in pursuit of minimal invasiveness. In the near future, robotic SPLS with natural orifice transluminal endoscopic surgery's way of specimen extraction seems to be pursued. It is expected to provide a completely or nearly complete seamless operation regardless of location of the lesion in the abdomen.
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Liu YY, Liao CH, Chen CC, Tsai CY, Liu KH, Wang SY, Fu CY, Yeh CN, Yeh TS. Single-Incision Laparoscopic-Assisted Jejunostomy Tube Placement. J Laparoendosc Adv Surg Tech A 2014; 24:22-7. [DOI: 10.1089/lap.2013.0360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yu-Yin Liu
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chi Chen
- Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Yi Tsai
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Keng-Hao Liu
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Nan Yeh
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Evaluation of Patient Satisfaction Using the EORTC IN-PATSAT32 Questionnaire and Surgical Outcome in Single-Port Surgery for Benign Adnexal Disease: Observational Comparison with Traditional Laparoscopy. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2013; 2013:578392. [PMID: 24371418 PMCID: PMC3859206 DOI: 10.1155/2013/578392] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/29/2013] [Accepted: 10/08/2013] [Indexed: 01/17/2023]
Abstract
Laparoscopic surgery has been demonstrated as a valid approach in almost all gynaecologic procedures including malignant diseases. Benefits of the minimally invasive approach over traditional open surgery have been well demonstrated in terms of minimal perioperative morbidity and reduced postoperative pain and hospital stay duration, with consequent quick postoperative recovery (Medeiros et al. (2009)). Single-port surgery resurfaced in gynaecology surgery in recent years and renewed interest among other surgeons and within the industry to develop this field (Podolsky et al. (2009)). Patient satisfaction is emerging as an increasingly important measure of quality which represents a complex entity that is dependent on patient demographics, comorbidities, disease, and, to a large extent, patient expectations (Tomlinson and Ko (2006)). It can be broadly thought to refer to all relevant experiences and processes associated with health care delivery (Jackson et al. (2001)). In this study we aim to compare single-port surgery (SPS) with conventional laparoscopy in terms of patient satisfaction using the EORTC IN-PATSAT32 questionnaire. We also evaluate the main surgical outcomes of both minimally invasive approaches.
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Wagner MJ, Kern H, Hapfelmeier A, Mehler J, Schoenberg MH. Single-port cholecystectomy versus multi-port cholecystectomy: a prospective cohort study with 222 patients. World J Surg 2013; 37:991-8. [PMID: 23435700 DOI: 10.1007/s00268-013-1946-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of this study was to compare single-port access cholecystectomy (SPA) with the standard laparoscopic technique (LC) regarding the duration of the operation, complications, learning curve, late postoperative quality of life (QoL) and the incidence of incisional hernias. METHODS Between June 2009 and December 2011, a total of 122 SPA cholecystectomies were performed in our hospital. Simultaneously, 310 patients were operated on with the LC technique. In the LC group, 100 patients met the same criteria defined for SPA surgery. The two groups (SPA and LC) were compared by multivariable regression analysis. Endpoints of this study were quality of life (QoL) after 6 months by the EQ-5D questionnaire 5L and the incidence of incisional hernia 1 year after surgery. Operating time, hospital stay, and perioperative complications were also measured and compared. The median follow-up was 9.2 months (3-25 months). RESULTS The patients in the SPA group were younger and more often female. The mean operating time for group SPA was 73 min (35-136 min)-significantly longer than that for group LC with 60 min (33-190 min) (p < 0.001). Additional trocars were used in 8 of 122 (6.5 %) SPA patients. A conversion to open cholecystectomy was not necessary in SPA patients. The conversion rate in the LC group to open cholecystectomy was 2 % (2/100). The perioperative and postoperative complications and incisional hernia (5.5 %) were the same in both groups. QoL was significantly better in the SPA group in terms of mobility (p = 0,002), usual activity (p = 0.036), and overall anxiety (p = 0.026). CONCLUSIONS SPA cholecystectomy is safe, although the operation is significantly longer. No differences in terms of major complications or the incidence of incisional hernia were seen after 1 year. QoL was significantly better in patients operated on with the SPA technique.
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Affiliation(s)
- Markus J Wagner
- Department of Surgery, Rotkreuzklinikum München, Munich, Germany
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Runge JJ, Mayhew PD. Evaluation of single port access gastropexy and ovariectomy using articulating instruments and angled telescopes in dogs. Vet Surg 2013; 42:807-13. [DOI: 10.1111/j.1532-950x.2013.12036.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 11/16/2012] [Indexed: 01/08/2023]
Affiliation(s)
- Jeffrey J. Runge
- Department of Clinical Studies; University of Pennsylvania; Philadelphia; PA
| | - Philipp D. Mayhew
- Department of Surgical and Radiological Sciences; University of California-Davis; Davis; CA
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Pan MX, Liang ZW, Cheng Y, Jiang ZS, Xu XP, Wang KH, Liu HY, Gao Y. Learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy. World J Gastroenterol 2013; 19:4786-4790. [PMID: 23922478 PMCID: PMC3732853 DOI: 10.3748/wjg.v19.i29.4786] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/15/2013] [Accepted: 06/20/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy (SILC).
METHODS: The clinical data of 180 consecutive transumbilical suture-suspension SILCs performed by a team in our department during the period from August 2009 to March 2011 were retrospectively analyzed. Patients were divided into nine groups according to operation dates, and each group included 20 patients operated on consecutively in each time period. The surgical outcome was assessed by comparing operation time, blood loss during operation, and complications between groups in order to evaluate the improvement in technique.
RESULTS: A total of 180 SILCs were successfully performed by five doctors. The average operation time was 53.58 ± 30.08 min (range: 20.00-160.00 min) and average blood loss was 12.70 ± 11.60 mL (range: 0.00-100.00 mL). None of the patients were converted to laparotomy or multi-port laparoscopic cholecystectomy. There were no major complications such as hemorrhage or biliary system injury during surgery. Eight postoperative complications occurred mainly in the first three groups (n = 6), and included ecchymosis around the umbilical incision (n = 7) which resolved without special treatment, and one case of delayed bile leakage in group 8, which was treated by ultrasound-guided puncture and drainage. There were no differences in intraoperative blood loss, postoperative complications and length of postoperative hospital stay among the groups. Bonferroni’s test showed that the operation time in group 1 was significantly longer than that in the other groups (F = 7.257, P = 0.000). The majority of patients in each group were discharged within 2 d, with an average postoperative hospital stay of 1.9 ± 1.2 d.
CONCLUSION: Following scientific principles and standard procedures, a team experienced in multi-port laparoscopic cholecystectomy can master the technique of SILC after 20 cases.
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Karakuş OZ, Hakgüder G, Ateş O, Olguner M, Akgür FM. Cholecystectomy Conducted with Single-Port Incisionless-Intracorporeal Conventional Equipment-Endoscopic Surgery. J Laparoendosc Adv Surg Tech A 2013; 23:728-32. [DOI: 10.1089/lap.2013.0026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Osman Z. Karakuş
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Gülce Hakgüder
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Oğuz Ateş
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Mustafa Olguner
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Feza M. Akgür
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
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Dursun P, Gülümser Ç, Çağlar M, Araz Ç, Zeyneloğlu H, Haberal A. Laparoendoscopic single-site surgery for acute adnexal pathology during pregnancy: preliminary experience. J Matern Fetal Neonatal Med 2013; 26:1282-6. [DOI: 10.3109/14767058.2013.783799] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Bedaiwy MA, Franjoine SE, Ali MK. Laparoendoscopic single-site (LESS) surgery in gynecology: Current status and future directions. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2013. [DOI: 10.1016/j.mefs.2012.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Shibao K, Higure A, Yamaguchi K. Laparoendoscopic single-site common bile duct exploration using the manual manipulator. Surg Endosc 2013; 27:3009-15. [PMID: 23436088 DOI: 10.1007/s00464-013-2837-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 01/04/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laparoendoscopic single-site (LESS) surgery has developed as a new surgical modality that has increased cosmetic benefits over conventional endoscopic surgery. However, there are no reports about LESS surgery in common bile duct exploration. This report presents a LESS surgery to manage CBD stones by laparoscopic choledochotomy and C-tube placement with favorable outcomes. METHODS This retrospective review analyzes 13 patients who underwent LESS CBD exploration with C-tube drainage for choledocholithiasis. The technique is herein described and the outcomes measured. The Radius Surgical System (Tübingen Scientific Medical, Tübingen, Germany) is a flexible manual manipulator that was applied for suturing and ligation to overcome the difficulties associated with LESS surgery. RESULTS The diameters of the CBDs ranged from 12 to 20 mm, the median number of stones was 5.8, and the median diameter of stones was 9 mm. All of the routine procedures including choledochotomy, intraoperative ultrasound, choledochoscopy, and intraoperative cholangiography guidance were performed. Stone clearance from the CBD was achieved for all but one of the patients. It was possible to close the common bile duct opening with regular forceps, but this required extra effort compared to conventional laparoscopic surgery. On the other hand, the manual manipulator enabled the optimal penetration angle and was useful for both intracorporeal suturing and ligation for the closure of the common bile duct opening. The manual manipulator also helped to overcome in-line viewing and hand/instruments collisions, which are common problems in LESS surgery. No mortality was associated with this procedure, and two wound infections were drained without anesthesia. No recurrent stones were observed during the follow-up period. CONCLUSIONS LESS surgery was successfully applied to CBD exploration as an available alternative to conventional laparoscopic surgery. This method is technically feasible and produces superior cosmetic results. The manual manipulator may therefore have several advantages for performing LESS surgery.
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Affiliation(s)
- Kazunori Shibao
- Department of Surgery I, School of Medicine, University of Occupational and Environmental Health Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Japan.
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Abe N, Takeuchi H, Ohki A, Aoki H, Masaki T, Mori T, Sugiyama M. Single-incision multiport laparoendoscopic surgery using a newly developed short-type flexible endoscope: a combined procedure of flexible endoscopic and laparoscopic surgery. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 19:426-30. [PMID: 21927879 DOI: 10.1007/s00534-011-0454-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVE We hypothesized that using a flexible endoscope as a working scope in laparoscopic surgery through a single incision might provide many benefits. To this end, a short-type flexible endoscope with a working length of 600 mm was newly developed. In this animal experimental study, we aimed to evaluate the technical feasibility of our new approach, single-incision multiport laparoendoscopic (SIMPLE) cholecystectomy, using this endoscope. METHODS Eight pigs were subjected to SIMPLE cholecystectomy using the short-type flexible endoscope. The endoscope was inserted through a 12-mm trocar in an SILS Port followed by the insertion of two additional 5-mm trocars in the SILS Port. Encirculation and ligation of the pedicle of the cystic artery and duct were carried out using laparoscopic instruments through the 5-mm trocars, while the dissection of the gallbladder from the intrahepatic fossa was predominantly performed using a cutting device through the endoscope. RESULTS A complete gallbladder excision, with complete encirculation and ligation of the pedicle, was completed in all cases. The mean operating time was 58 min (range 34-78 min). The endoscope provided a good view of the operating field, and it allowed some degree of freedom to the working laparoscopic instruments without compromising the field of view. Dissection of the gallbladder using the cutting device through the endoscope was much easier than that using the laparoscopic device, because the articulating instruments together with the endoscope enabled operation with triangulation. Furthermore, the water-jet and suctioning functions and the self-cleaning lens capability of the endoscope served the surgery well. CONCLUSIONS SIMPLE cholecystectomy using the newly developed short-type flexible endoscope is a technically feasible procedure. Using this flexible endoscope for various tasks, such as resection, suctioning, and smoke evacuation, can make the surgical procedures easier.
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Affiliation(s)
- Nobutsugu Abe
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan.
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Single-port laparoscopic distal gastrectomy with D1+β lymph node dissection for gastric cancers: report of 2 cases. Surg Laparosc Endosc Percutan Tech 2012; 22:e214-6. [PMID: 22874704 DOI: 10.1097/sle.0b013e318253df9b] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The use of single-port laparoscopic surgery for treating various diseases has increased rapidly. This approach can offer better cosmetic results and less incisional pain. We report the cases of single-port laparoscopic distal gastrectomy with D1+β lymph node dissection for 2 patients with gastric cancers.
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Chern BSM, Lakhotia S, Khoo CK, Siow AYM. Single incision laparoscopic surgery in gynecology: Evolution, current trends, and future perspectives. Gynecol Minim Invasive Ther 2012. [DOI: 10.1016/j.gmit.2012.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Wang Z, Huang X, Zheng Q. Single-incision versus conventional laparoscopic cholecystectomy: a meta-analysis. ANZ J Surg 2012; 82:885-9. [PMID: 23009184 DOI: 10.1111/j.1445-2197.2012.06284.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Conventional laparoscopic cholecystectomy (CLC) is now accepted as the gold standard surgical treatment for gallbladder stone disease. Single-incision laparoscopic technology has recently been introduced into laparoscopic clinical practice in order to reduce the invasiveness of this procedure. A meta-analysis of randomized clinical trials (RCTs) was performed to compare single-incision laparoscopic cholecystectomy (SICL) and CLC. METHODS Medline, Embase, ISI Web of Knowledge CPCI-S and the Cochrane Library were searched and the methodological quality of the included trials was evaluated. Outcomes evaluated were adverse events, conversion rate, post-operative hospital stay, blood loss, post-operative pain, total wound length, operative time and wound satisfaction score. Results were pooled in meta-analyses as odds ratio and weighted mean differences (WMD). RESULTS Five RCTs on 264 patients qualified for the meta-analysis, 139 being allocated to SILC and 125 to CLC. There was no significant difference between SICL and CLC for adverse events, conversion rate, post-operative hospital stay, blood loss, post-operative pain and total wound length; however, operative time was significantly longer in SICL than in CLC (WMD 7.72 (95% confidence interval (CI): 1.38-14.07) min; P = 0.02, χ(2) P = 0.02, I(2) = 69%). Furthermore, wound satisfaction score was significantly higher in SICL than in CLC (WMD 1.40 (95% CI: 1.19-1.61) min; P < 0.00001, χ(2) P = 0.19, I(2) = 42%). CONCLUSION SILC may be superior to CLC in terms of cosmetic outcome, but not in operative time. Currently, SILC is a safe procedure for proper patients in experienced surgeons.
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Affiliation(s)
- Zhanhui Wang
- Department of General Surgery, Zhengzhou University Affiliated Luoyang Central Hospital, Luoyang, China.
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Ross S, Rosemurgy A, Albrink M, Choung E, Dapri G, Gallagher S, Hernandez J, Horgan S, Kelley W, Kia M, Marks J, Martinez J, Mintz Y, Oleynikov D, Pryor A, Rattner D, Rivas H, Roberts K, Rubach E, Schwaitzberg S, Swanstrom L, Sweeney J, Wilson E, Zemon H, Zundel N. Consensus statement of the consortium for LESS cholecystectomy. Surg Endosc 2012; 26:2711-6. [PMID: 22936433 DOI: 10.1007/s00464-012-2478-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 04/19/2012] [Indexed: 02/03/2023]
Abstract
Many surgeons attempting Laparo-Endoscopic Single Site (LESS) cholecystectomy have found the operation difficult, which is inconsistent with our experience. This article is an attempt to promote a standardized approach that we feel surgeons with laparoscopic skills can perform safely and efficiently. This is a four-trocar approach consistent with the four incisions utilized in conventional laparoscopic cholecystectomy. After administration of general anesthesia, marcaine is injected at the umbilicus and a 12-mm vertical incision is made through the already existing anatomical scar of the umbilicus. A single four-trocar port is inserted. A 5-mm deflectable-tip laparoscope is placed through the trocar at the 8 o'clock position, a bariatric length rigid grasper is inserted through the trocar at the 4 o'clock position (to grasp the fundus), and a rigid bent grasper is placed through the 10-mm port (to grasp the infundibulum). This arrangement of the instruments promotes minimal internal and external instrument clashing with simultaneous optimization of the operative view. This orientation allows retraction of the gallbladder in a cephalad and lateral direction, development of a window between the gallbladder and the liver which promotes the "critical view" of the cystic duct and artery, and provides triangulation with excellent visualization of the operative field. The operation is concluded with diaphragmatic irrigation of marcaine solution to minimize postoperative pain. Standardization of LESS cholecystectomy will speed adoption, reduce intraoperative complications, and improve the efficiency and safety of the approach.
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Affiliation(s)
- Sharona Ross
- HPB & Foregut Advanced Laparoscopic & Robotic Surgery, Florida Hospital Tampa, 3100 East Fletcher Avenue, Suite 310, Tampa, Florida 33613, USA.
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Fransen S, Stassen L, Bouvy N. Single incision laparoscopic cholecystectomy: A review on the complications. J Minim Access Surg 2012; 8:1-5. [PMID: 22303080 PMCID: PMC3267328 DOI: 10.4103/0972-9941.91771] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 03/30/2011] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND: The aim of this study was to establish the incidence of postoperative complications after single incision laparoscopic cholecystectomy. MATERIALS AND METHODS: A literature search was performed using the PubMed database. Search terms included single incision laparoscopic cholecystectomy, single port cholecystectomy, minimal invasive laparoscopic cholecystectomy, nearly scarless cholecystectomy and complications. RESULTS: A total of 38 articles meeting the selection criteria were reviewed. A total of 1180 patients were selected to undergo single incision laparoscopic cholecystectomy. Introduction of extra ports was necessary in 4% of the patients. Conversion to open cholecystectomy was required in 0.4% of the patients. Laparoscopic cholangiography was attempted in 4% of the patients. The incidence of major complications requiring surgical intervention or ERCP with stenting was 1.7%. The mortality rate was zero. CONCLUSION: Although the number of complications after single incision laparoscopic cholecystectomy seems favourable, it is too early to conclude that single incision laparoscopic cholecystectomy is a safe procedure. Large randomised controlled trials will be necessary to further establish its safety.
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Affiliation(s)
- Sofie Fransen
- Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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Runge JJ, Curcillo PG, King SA, Podolsky ER, Holt DE, Davidson J, Agnello KA. Initial Application of Reduced Port Surgery Using the Single Port Access Technique for Laparoscopic Canine Ovariectomy. Vet Surg 2012; 41:803-6. [DOI: 10.1111/j.1532-950x.2012.01012.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Jeffrey J. Runge
- Department of Clinical Studies, Section of Surgery; Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania; Philadelphia; PA
| | - Paul G. Curcillo
- Departments of Surgery; Fox Chase Cancer Center; Philadelphia; PA
| | | | | | - David E. Holt
- Department of Clinical Studies, Section of Surgery; Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania; Philadelphia; PA
| | - Jeffrey Davidson
- Department of Clinical Studies, Section of Surgery; Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania; Philadelphia; PA
| | - Kimberly A. Agnello
- Department of Clinical Studies, Section of Surgery; Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania; Philadelphia; PA
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Sharma A, Soni V, Baijal M, Khullar R, Najma K, Chowbey PK. Single port versus multiple port laparoscopic cholecystectomy-a comparative study. Indian J Surg 2012; 75:115-22. [PMID: 24426405 DOI: 10.1007/s12262-012-0680-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 06/22/2012] [Indexed: 02/06/2023] Open
Abstract
Single port laparoscopic cholecystectomy (SPLC) was introduced to minimize postoperative morbidity and improve cosmesis. We performed a comparative study to assess feasibility, safety and perceived benefits of SPLC. Two groups of patients (104 each) with comparable demographic characteristics were selected for SPLC and multiport laparoscopic cholecystectomy (MPLC) between May 2010 to March 2011. SPLC was performed using X cone® with 5 mm extra long telescope and 3 ports for hand instruments. MPLC was performed with traditional 4 port technique. A large window was always created during dissection to obtain the critical view of safety. Data collection was prospective. The primary end points were post-operative pain and surgical complications. Secondary end points were patient assessed cosmesis and satisfaction scores and operating time. The mean VAS scores for pain in SPLC group were higher on day 0 (SPLC 3.37 versus MPLC 2.72, p = 0.03) and equivalent to MPLC group on day 1(SPLC 1.90 versus MPLC 1.79, p = 0.06). Number of patients requiring analgesia for breakthrough pain (SPLC 21.1 % versus MPLC 26.9 %, p = 0.31) was similar. Number and nature of surgical complications was similar (SPLC 17.3 % versus MPLC 21.2 %, p =0.59). Mean patient assessed cosmesis scores (SPLC 7.96 versus MPLC 7.16, p = 0.003) and mean patient satisfaction scores (SPLC 8.66 versus MPLC 8.16, p = 0.004) were higher in SPLC group indicating better cosmesis and greater patient satisfaction. SPLC took longer to perform (61 min versus 26 min, p = 0.00). Conversion was required in 5 patients in SPLC group. SPLC appears to be feasible and safe with cosmetic benefits in selected patients. However, challenges remain to improve operative ergonomics. SPLC needs to be proven efficacious with a high safety profile to be accepted as standard laparoscopic technique.
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Affiliation(s)
- A Sharma
- Max Institute of Minimal Access, Metabolic & Bariatric Surgery, Max Healthcare Institute Ltd., 1-2, Press Enclave Road, Saket, New Delhi 110017 India
| | - V Soni
- Max Institute of Minimal Access, Metabolic & Bariatric Surgery, Max Healthcare Institute Ltd., 1-2, Press Enclave Road, Saket, New Delhi 110017 India
| | - M Baijal
- Max Institute of Minimal Access, Metabolic & Bariatric Surgery, Max Healthcare Institute Ltd., 1-2, Press Enclave Road, Saket, New Delhi 110017 India
| | - R Khullar
- Max Institute of Minimal Access, Metabolic & Bariatric Surgery, Max Healthcare Institute Ltd., 1-2, Press Enclave Road, Saket, New Delhi 110017 India
| | - K Najma
- Max Institute of Minimal Access, Metabolic & Bariatric Surgery, Max Healthcare Institute Ltd., 1-2, Press Enclave Road, Saket, New Delhi 110017 India
| | - P K Chowbey
- Max Institute of Minimal Access, Metabolic & Bariatric Surgery, Max Healthcare Institute Ltd., 1-2, Press Enclave Road, Saket, New Delhi 110017 India
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Single-port laparoscopic surgery in children: concept and controversies of the new technique. Minim Invasive Surg 2012; 2012:232347. [PMID: 22778945 PMCID: PMC3384965 DOI: 10.1155/2012/232347] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Revised: 03/30/2012] [Accepted: 04/11/2012] [Indexed: 12/18/2022] Open
Abstract
Single-incision laparoscopic surgery (SILS) is emerging as an alternative technique to conventional laparoscopy for the treatment of common surgical diseases. Despite its wide use, the adoption of SILS in children has been slower since the broad application of minimally invasive techniques in children, in general, has historically lagged behind those in adults. This paper reviews the evolution of SILS from its original conception and its application in the field of pediatric surgery.
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Ruffo G, Barugola G, Scopelliti F, Sartori A, Crippa S, Partelli S, Falconi M. SILS cholecystectomy, early experience of a single institution: pilot study of 21 cases. Updates Surg 2012; 64:145-8. [DOI: 10.1007/s13304-012-0151-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 03/22/2012] [Indexed: 10/28/2022]
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Vidal ÓS, Pavel M, Valentini M, GinestÀ C, MartÍ J, Saavedra D, Espert JJ, Benarroch G, GarcÍA-Valdecasas JC. Single-Incision Laparoscopic Cholecystectomy for Day Surgery Procedure: Are We Prepared? Am Surg 2012. [DOI: 10.1177/000313481207800434] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Single-incision laparoscopic surgery (SILS) for cholecystectomy is a well-established procedure and represents the next step in developing the concept of fast track surgery. This report describes our experience with SILS cholecystectomy in patients that stay overnight. Between February 2009 and July 2010, patients referred for cholecystectomy to the day surgery unit who agreed to undergo SILS were included in a prospective study. All operations were performed by the same surgical team specially trained in this type of surgery and the same operative technique was used in all cases. Postoperative pain and nausea were assessed using a 10-cm visual analogue scale on a self-completion questionnaire on the night of operation and the morning of discharge. A total of 107 patients (58% women, mean age 56 years) with symptomatic gallstones were included in the study. SILS was successfully performed in all patients and no patient required conversion to an open procedure. There were no significant differences in the median visual analogue scale for postoperative pain and nausea between the night of surgery and the next morning. The mean length of hospital stay was 23 hours, and 98 per cent of patients were satisfied with the results of surgery and would be willing to undergo the same procedure again. SILS cholecystectomy is a valid alternative to standard laparoscopic cholecystectomy as an outpatient surgery or overnight stay procedure. According to these promising results, SILS cholecystectomy could be included in a major ambulatory surgery program.
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Affiliation(s)
- ÓScar Vidal
- General and Endocrine Unit, Department of Digestive Surgery, Digestive Diseases and Metabolism Institute, Hospital Clínic i Provincial, Universitat de Barcelona, Barcelona, Spain
| | - Mihai Pavel
- General and Endocrine Unit, Department of Digestive Surgery, Digestive Diseases and Metabolism Institute, Hospital Clínic i Provincial, Universitat de Barcelona, Barcelona, Spain
| | - Mauro Valentini
- General and Endocrine Unit, Department of Digestive Surgery, Digestive Diseases and Metabolism Institute, Hospital Clínic i Provincial, Universitat de Barcelona, Barcelona, Spain
| | - Cesar GinestÀ
- General and Endocrine Unit, Department of Digestive Surgery, Digestive Diseases and Metabolism Institute, Hospital Clínic i Provincial, Universitat de Barcelona, Barcelona, Spain
| | - Josep MartÍ
- General and Endocrine Unit, Department of Digestive Surgery, Digestive Diseases and Metabolism Institute, Hospital Clínic i Provincial, Universitat de Barcelona, Barcelona, Spain
| | - David Saavedra
- General and Endocrine Unit, Department of Digestive Surgery, Digestive Diseases and Metabolism Institute, Hospital Clínic i Provincial, Universitat de Barcelona, Barcelona, Spain
| | - Juan J. Espert
- General and Endocrine Unit, Department of Digestive Surgery, Digestive Diseases and Metabolism Institute, Hospital Clínic i Provincial, Universitat de Barcelona, Barcelona, Spain
| | - Guerson Benarroch
- General and Endocrine Unit, Department of Digestive Surgery, Digestive Diseases and Metabolism Institute, Hospital Clínic i Provincial, Universitat de Barcelona, Barcelona, Spain
| | - Juan C. GarcÍA-Valdecasas
- General and Endocrine Unit, Department of Digestive Surgery, Digestive Diseases and Metabolism Institute, Hospital Clínic i Provincial, Universitat de Barcelona, Barcelona, Spain
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Ball CG, Kirkpatrick AW, Williams DR, Jones JA, Polk JD, Vanderploeg JM, Talamini MA, Campbell MR, Broderick TJ. Prophylactic surgery prior to extended-duration space flight: is the benefit worth the risk? Can J Surg 2012; 55:125-31. [PMID: 22564516 PMCID: PMC3310768 DOI: 10.1503/cjs.024610] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2011] [Indexed: 01/04/2023] Open
Abstract
This article explores the potential benefits and defined risks associated with prophylactic surgical procedures for astronauts before extended-duration space flight. This includes, but is not limited to, appendectomy and cholecystesctomy. Furthermore, discussion of treatment during space flight, potential impact of an acute illness on a defined mission and the ethical issues surrounding this concept are debated in detail.
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Affiliation(s)
- Chad G Ball
- Department of Surgery, University of Calgary, Calgary, Alta.
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Technical considerations in children undergoing laparoscopic ileal-J-pouch anorectal anastomosis for ulcerative colitis. Pediatr Surg Int 2012; 28:351-6. [PMID: 22127486 DOI: 10.1007/s00383-011-3030-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sub-total colectomy and restorative proctocolectomy with j-pouch ileo-anorectal anastomosis is the treatment of choice in children with ulcerative colitis uncontrolled with medical therapy. OBJECTIVE To present some technical considerations about children undergoing laparoscopic ileal-J-pouch anorectal anastomosis. SETTINGS AND PATIENTS All patients with ulcerative colitis undergoing laparoscopic ileal-J-pouch anorectal anastomosis were evaluated from January 2006 to February 2011. INTERVENTION The new technical innovations herein are (1) total laparoscopic approach, (2) a very short 3-cm J-pouch ileal reservoir created outside the stoma incision, (3) preservation of the entire anal canal and the Knight-Griffen double stapled anastomosis, less than 3 cm from the dentate line, (4) use of a Multiple Instrument Access Port system in the stoma skin incision to reduce the number of port site incisions and (5) proctectomy performed using only an electrosurgical vessels sealing device thus avoiding clips to close rectal pedicle. RESULTS Seventeen laparoscopic ileo J-pouch low rectal anastomosis were performed by the same surgical staff. Three complications occurred postoperatively: one bowel obstruction, one ileostomy prolapse, and one anastomotic stricture. Satisfactory functional results were achieved in all, there was no significant perineal excoriation and quality of life was excellent. CONCLUSIONS A Multiport Instrument Access Port placed in the stoma site allowed the use of more instruments through a single incision. The very short ileo J-pouch low rectal anastomosis has been shown to be a safe, feasible, and effective reconstructive procedure.
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Single-incision and dual-incision laparoscopic adjustable gastric band: evaluation of initial experience. Surg Obes Relat Dis 2012; 8:194-200. [DOI: 10.1016/j.soard.2010.09.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 08/19/2010] [Accepted: 09/25/2010] [Indexed: 01/23/2023]
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Katz MS, Schwartz MZ, Moront ML, Arthur LG, Timmapuri SJ, Nagy BK, Prasad R. Single-Incision Thoracoscopic Surgery in Children: Equivalent Results with Fewer Scars When Compared with Traditional Multiple-Incision Thoracoscopy. J Laparoendosc Adv Surg Tech A 2012; 22:180-3. [DOI: 10.1089/lap.2011.0105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael S. Katz
- Department of Pediatric General, Thoracic, and Minimally Invasive Surgery, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Marshall Z. Schwartz
- Department of Pediatric General, Thoracic, and Minimally Invasive Surgery, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Matthew L. Moront
- Department of Pediatric General, Thoracic, and Minimally Invasive Surgery, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Lindsay G. Arthur
- Department of Pediatric General, Thoracic, and Minimally Invasive Surgery, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Shaheen J. Timmapuri
- Department of Pediatric General, Thoracic, and Minimally Invasive Surgery, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Brittany K. Nagy
- Department of Pediatric General, Thoracic, and Minimally Invasive Surgery, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Rajeev Prasad
- Department of Pediatric General, Thoracic, and Minimally Invasive Surgery, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
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Conventional laparoscopic adrenalectomy versus laparoscopic adrenalectomy through mono port. Surg Laparosc Endosc Percutan Tech 2012; 21:439-42. [PMID: 22146168 DOI: 10.1097/sle.0b013e31823a9ab7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A standard procedure for single-port laparoscopic adrenal surgery has not been established. We retrospectively investigated intraoperative and postoperative outcomes after laparoscopic adrenalectomy through mono port (LAMP) and conventional laparoscopic adrenalectomy to assess the feasibility of LAMP. Between March 2008 and December 2009, 22 patients underwent adrenalectomy at the Department of Surgery, Kangbuk Samsung Hospital. Twelve patients underwent conventional laparoscopic adrenalectomy and 10 patients underwent LAMP. The same surgeon performed all the surgeries. The 2 procedures were compared in terms of tumor size, operating time, time to resumption of a soft diet, length of hospital day, and postoperative complications. The 2 groups were similar in terms of tumor size (30.08 vs. 32.50 mm, P=0.796), mean operating time (112.9 vs. 127 min, P=0.316), time to resumption of a soft diet (1.25 vs. 1.30 d, P=0.805), and length of hospital day (4.08 vs. 4.50 d, P=0.447). Despite 1 patient in the LAMP group experiencing ipsilateral pleural effusion as a postoperative complication, this parameter was similar for the 2 groups (P=0.195). Perioperative mortality, blood transfusion, and conversion to open surgery did not occur. Perioperative outcomes for LAMP were similar to those for conventional laparoscopic adrenalectomy. LAMP appears to be a feasible option for adrenalectomy.
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Suda T, Sugimura H, Tochii D, Kihara M, Hattori Y. Single-port thymectomy through an infrasternal approach. Ann Thorac Surg 2012; 93:334-6. [PMID: 22186468 DOI: 10.1016/j.athoracsur.2011.08.047] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/31/2011] [Accepted: 08/24/2011] [Indexed: 10/14/2022]
Abstract
We report a surgical procedure in which a port and devices designed for single-incision endoscopic surgery are employed for thymectomy through an infrasternal approach. As this single-port thymectomy procedure can be performed through a single 3.5-cm incision in the abdominal region usually concealed under clothes, it is esthetically excellent and is among the least invasive thymectomy procedures because no sternal incision is applied and no intercostal nerve is injured. Investigation of the safety of this procedure and long-term therapeutic outcomes for myasthenia gravis and anterior mediastinal tumors is necessary.
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Affiliation(s)
- Takashi Suda
- Division of Thoracic Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
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Cao LP, Que RS, Zhou F, Ding GP, Jing DX. Transumbilical single-port laparoscopic cholecystectomy using traditional laparoscopic instruments: a report of thirty-six cases. J Zhejiang Univ Sci B 2012; 12:862-6. [PMID: 21960350 DOI: 10.1631/jzus.b1000384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the feasibility and safety of the operation of transumbilical single-port laparoscopic cholecystectomy (TSPLC) by traditional laparoscopic instruments and summarize the initial experience. METHODS Sixty subjects with cholelithiasis were divided into two groups. One group (36 cases) underwent TSPLC and the control group (24 cases) underwent traditional three-port laparoscopic cholecystectomy (LC). Postoperative complications were observed and operation time, hospital days, visual analogue scale (VAS) after 6 and 24 h of operation, and subject satisfaction score were measured. RESULTS TSPLC and traditional LC were performed successfully in the two groups. The operation time in the TSPLC group was significantly longer than that in the control group. There was no statistically significant difference in hospital stay and VAS between the TSPLC and control groups. The subject satisfaction score in the TSPLC group was 91.2, significantly higher than that in the control group (P<0.01). All subjects recovered from the operation and no postoperative complication occurred during the period of two weeks after operation. CONCLUSIONS TSPLC is a feasible and safe method for cholecystectomy, although it may be more time-consuming. However, it is welcomed by patients who are more concerned with cosmetic outcomes. Future studies are needed to confirm its disadvantages and contraindications.
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Affiliation(s)
- Li-ping Cao
- Department of Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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