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Irfan A, Rao A, Ahmed I. Single-incision versus conventional multi-incision laparoscopic appendicectomy for suspected uncomplicated appendicitis. Cochrane Database Syst Rev 2024; 11:CD009022. [PMID: 39498756 PMCID: PMC11536430 DOI: 10.1002/14651858.cd009022.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2024]
Abstract
BACKGROUND Appendicectomy is a well-established surgical procedure to manage acute appendicitis. The operation was historically performed as an open procedure and is currently performed using minimally invasive surgical techniques. A recent development in appendicectomy technique is the introduction of single-incision laparoscopic surgery. This incorporates all working ports (either one multi-luminal port or multiple mono-luminal ports) through a single skin incision; the procedure is known as single-incision laparoscopic appendicectomy or SILA. Unanswered questions remain regarding the efficacy of this novel technique, including its effects on patient benefit and satisfaction, complications, and long-term outcomes, when compared to multi-incision conventional laparoscopy (CLA). This is an update of a review published in 2011. OBJECTIVES To assess the effects of single-incision laparoscopic appendicectomy compared with multi-incision laparoscopic appendicectomy, on benefits, complications, and short-term outcomes, in patients with acute appendicitis. SEARCH METHODS We searched the Cochrane Central Register of Controlled trials (CENTRAL, the Cochrane Library 2018 Issue 2), Ovid MEDLINE (1983 to January 2024), Ovid Embase (1983 to January 2024), the WHO International Clinical Trial Register (January 2024), and Clinicaltrials.gov (January 2024). We also searched reference lists of relevant articles and reviews, conference proceedings, and ongoing trial databases. The searches were carried out on 20 January 2024. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared the single-incision procedure SILA against CLA for patients (male and female) over the age of 10 years, diagnosed with appendicitis, or symptoms of appendicitis, and undergoing laparoscopic appendicectomy. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, extracted data into a standardised form, and assessed the risk of bias in the studies. We extracted data relevant to the predetermined outcome measures. Where appropriate, we calculated a summary statistic: odds ratio (OR) with 95% confidence intervals (CIs) for dichotomous data and mean difference (MD) with 95% CI for continuous data. We used Review Manager Web for our statistical analysis. MAIN RESULTS This review was first published in 2011, when there was no RCT evidence available. For this update, we identified 11 RCTs involving 1373 participants (689 in the SILA groups and 684 in the CLA groups). The participants were similar at baseline in terms of age (mean 31.7 (SILA) versus 30.9 years (CLA)) and sex (female: 53.0% (SILA) versus 50.3% (CLA)). Diagnosis of appendicitis was based on clinical assessment; none of the studies used a diagnosis confirmed by imaging as part of their inclusion criteria. The certainty of the evidence was low to moderate, and the outcomes were predominately reported in the short term. Pain scores at 24 hours after surgery may be similar between the SILA and CLA groups (mean score SILA 2.53 versus CLA 2.65; mean difference (MD) in pain score -0.12, 95% CI -0.52 to 0.28; 294 participants, 4 RCTs; low-certainty evidence). SILA probably had superior cosmetic results as indicated by patients using the Body Image questionnaire (5 to 20) (mean score SILA 14.9 versus CLA 12.4; cosmesis score MD 1.97, 95% CI 1.60 to 2.33; 266 participants, 3 RCTs; moderate-certainty evidence). The rate of visceral and vascular injury was probably similar with both techniques (SILA 0/168 versus 4/169; OR 0.20, 95% CI 0.02 to 1.79; 337 participants, 3 RCTs; moderate-certainty evidence). The conversion rate to CLA or open surgery may be higher for SILA procedures than the conversion rate from CLA to open surgery (SILA 32/574 versus CLA 7/569; OR 2.95, 95% CI 1.36 to 6.42; 1143 participants, 9 RCTs; low-certainty evidence). Use of an additional port site was probably more likely with SILA compared to CLA (SILA 28/328 versus CLA 4/336; OR 3.80, 95% CI 1.13 to 12.72; 664 participants, 5 RCTs; moderate-certainty evidence). The recovery time was probably similar for both interventions for hospital stay (mean length of stay in hospital for SILA 2.25 days versus 2.29 days for CLA patients; MD -0.13, 95% CI -0.23 to 0.03; 1241 participants, 10 RCTs; moderate-certainty evidence) and time to return to normal activities (SILA 9.28 days versus CLA 10.0 days; MD -0.59, 95% CI -1.99 to 0.81; 451 participants, 4 RCTs; moderate-certainty evidence). We have low-to-moderate confidence in our findings due to differences in the measurement of certain outcomes, and lack of blinding in the studies, which makes them prone to performance bias. AUTHORS' CONCLUSIONS There is low-to-moderate certainty evidence that single-incision laparoscopic appendicectomy is comparable to conventional laparoscopic appendicectomy in terms of complications, length of hospital stay, return to normal activities, and postoperative pain in the first 24 hours. The disadvantage of SILA may be a higher conversion rate, but SILA is probably associated with better patient cosmetic satisfaction.
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Affiliation(s)
- Ahmer Irfan
- Department of Surgery, Toronto General Hospital, Toronto, Canada
| | - Ahsan Rao
- Department of Surgery, Mid and South Essex NHS Trust, Basildon, UK
| | - Irfan Ahmed
- Department of HPB Surgery and Liver Tx, Pakistan Kidney and Liver Institute and Research Center (PKLI&RC), Lahore, Pakistan
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Rajapandian S, Dey S, Jain M, Sabnis S, Palanisamy S, Palanivelu P, Ramakrishnan P, Chinnusamy P. Evaluation of Single-Incision Multiport Laparoscopic Appendectomy (SIMPLA) Performed with Conventional Equipment. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1782-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Vellei S, Borri A. Single-Incision Versus Three-Port Laparoscopic Appendectomy: Short- and Long-Term Outcomes. J Laparoendosc Adv Surg Tech A 2017; 27:804-811. [PMID: 28402744 DOI: 10.1089/lap.2016.0406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
AIM To compare the outcome of patients who had undergone single-incision laparoscopic appendectomy (SILA) with others who had undergone three-port laparoscopic appendectomy (3-PORT). MATERIALS AND METHODS Data from all adults with uncomplicated appendicitis treated by laparoscopic appendectomy between June 2012 and December 2015 were prospectively collected. Patients with chronic pain, appendix malignancy, at least two previous laparotomies, and those undergoing concomitant surgery for different condition were excluded from analysis. Postoperative pain was assessed by a visual analog scale (VAS). Patients were reviewed postoperatively at 7 days and 1 month in the outpatient clinic. Late complications were assessed with a telephonic interview. RESULTS A total of 91 patients were included (46 SILA; 45 3-PORT). There were 16 males and 30 females in the SILA group (mean age = 26.76 ± 10.58 years) and 18 males and 27 females in the 3-PORT group (mean age = 26.84 ± 10.79 years). The mean operative time for SILA was 48.54 ± 12.80 min, for the 3-PORT group the mean operative time was 46.33 ± 15.54 min (P = 0.46). No case required conversion. Mean postoperative hospital length of stay was 1.87 ± 0.69 days for SILA and 2.38 ± 1.11 days for 3-PORT (P = 0.01). VAS value of 3.91 ± 1.96 and mean ketorolac usage of 0.38 ± 0.65 in 3-PORT group and SILA patients reported 3.70 ± 1.58 and 0.39 ± 0.58, respectively (P = 0.91). Our mean follow-up in SILA group was 25.75 ± 10.82 months, for 3-PORT group the mean follow-up was 26.9 ± 11.8 months. Eleven patients missed long-term follow-up. No incisional hernia was found. There is a statistically significant difference in cosmetic evaluation in favor of SILA (P < 0.005). CONCLUSIONS There was no difference in operative time, early complications, postoperative pain, analgesia requirement between SILA and 3-PORT laparoscopic appendectomy, but after SILA procedure discharge was quicker and long-term cosmetic satisfaction was superior.
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Affiliation(s)
- Samatha Vellei
- 1 Department of Surgery and Translational Medicine, University of Florence , Florence, Italy
| | - Alessandro Borri
- 2 Department of Emergency and Accident, Azienda Ospedaliera Universitaria Careggi (AOUC) , Florence, Italy
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Dimitrokallis N, Alexandrou A, Schizas D, Angelou A, Pikoulis E, Liakakos T. Single-Incision Laparoscopic Sleeve Gastrectomy: Review and a Critical Appraisal. J Laparoendosc Adv Surg Tech A 2017; 27:217-226. [PMID: 28146416 DOI: 10.1089/lap.2016.0591] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Single-incision laparoscopic surgery has attracted a great deal of interest in the surgical community in recent years, including bariatric surgery. Single-incision laparoscopic sleeve gastrectomy (SILSG) has been proposed as an alternative to the multiport laparoscopic procedure; however, it has yet to meet wide acceptance and application. OBJECTIVE We aim to summarize existing data on SILSG and check the procedure's feasibility, technical details, safety, and, if possible, outcomes. MATERIALS AND METHODS We checked the most important databases for studies concerning SILSG and included all these that summarized the criteria placed and contained the data needed for this review. We excluded case reports. RESULTS Nineteen studies complied with the criteria of our review, containing a total of 1679 patients. Their mean age has been 38.91 years and the mean preoperative body mass index has been 41.8 kg/m2. In majority of cases (60.5%), a left upper quadrant incision has been preferred and in 97.6%, a commercially available multiport system has been picked. A wide variety of instruments have been used and mean operating time has been 94.6 minutes. One conversion to open surgery has been reported and 7.4% required the placement of additional ports. There was a complication rate of 7.38% (most common being bleeding with a rate of 2.5%) and a reoperation rate of 2.8%. Mean excess weight loss for a follow-up of 1 year was achieved in 53.7% of patients and was 70.06%. A tendency for less analgesia and better wound satisfaction has been reported. CONCLUSIONS SILSG is safe and feasible. However, there is insufficient evidence to recommend it as the new gold standard for sleeve gastrectomy in the place of conventional laparoscopic sleeve gastrectomy. Randomized controlled trials are needed to analyze the results and the possible benefits of this technique.
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Affiliation(s)
- Nikolaos Dimitrokallis
- 1st Department of Surgery, National Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Andreas Alexandrou
- 1st Department of Surgery, National Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, National Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Anastasios Angelou
- 1st Department of Surgery, National Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Emmanouil Pikoulis
- 1st Department of Surgery, National Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Theodoros Liakakos
- 1st Department of Surgery, National Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Guo W, Liu Y, Han W, Liu J, Jin L, Li JS, Zhang ZT. Randomized Trial of Immediate Postoperative Pain Following Single-incision Versus Traditional Laparoscopic Cholecystectomy. Chin Med J (Engl) 2016; 128:3310-6. [PMID: 26668145 PMCID: PMC4797506 DOI: 10.4103/0366-6999.171422] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We undertook a randomized controlled trial to ascertain if single-incision laparoscopic cholecystectomy (SILC) was more beneficial for reducing postoperative pain than traditional laparoscopic cholecystectomy (TLC). Moreover, the influencing factors of SILC were analyzed. METHODS A total of 552 patients with symptomatic gallstones or polyps were allocated randomly to undergo SILC (n = 138) or TLC (n = 414). Data on postoperative pain score, operative time, complications, procedure conversion, and hospital costs were collected. After a 6-month follow-up, all data were analyzed using the intention-to-treat principle. RESULTS Among SILC group, 4 (2.9%) cases required conversion to TLC. Mean operative time of SILC was significantly longer than that of TLC (58.97 ± 21.56 vs. 43.38 ± 19.02 min, P < 0.001). The two groups showed no significant differences in analgesic dose, duration of hospital stay, or cost. Median pain scores were similar between the two groups 7 days after surgery, but SILC-treated patients had a significantly lower median pain score 6 h after surgery (10-point scale: 3 [2, 4] vs. 4 [3, 5], P = 0.009). Importantly, subgroup analyses of operative time for SILC showed that a longer operative time was associated with greater prevalence of pain score >5 (≥100 min: 5/7 patients vs. <40 min, 3/16 patients, P = 0.015). CONCLUSIONS The primary benefit of SILC appears to be slightly less pain immediately after surgery. Surgeon training seems to be important because the shorter operative time for SILC may elicit less pain immediately after surgery.
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Affiliation(s)
| | | | | | | | | | | | - Zhong-Tao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Beijing 100050, China
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Single-incision flexible endoscopy (SIFE) for detection and staging of peritoneal carcinomatosis. Surg Endosc 2015; 30:3808-15. [DOI: 10.1007/s00464-015-4682-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/14/2015] [Indexed: 01/19/2023]
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Bracale U, Melillo P, Lazzara F, Andreuccetti J, Stabilini C, Corcione F, Pignata G. Single-Access Laparoscopic Rectal Resection Versus the Multiport Technique. Surg Innov 2015; 22:46-53. [DOI: 10.1177/1553350614529668] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background. Single-access laparoscopic surgery is not used routinely for the treatment of colorectal disease. The aim of this retrospective cohort study is to compare the results of single-access laparoscopic rectal resection (SALR) versus multiaccess laparoscopic rectal resection with a mean follow-up of 24 months. Methods. This retrospective cohort study enrolled 42 patients. Between January 2010 and June 2012, 21 SALRs were performed. These patients were compared with a group of 21 other patients who had undergone multiport laparoscopic rectal resection. This control group had the same exclusion criteria and patient demographics. Short-term outcomes were reassessed with a mean follow-up of 2 years. Statistical analysis included the Student t test and Fisher’s exact test. Finally, we performed a differential cost analysis between the 2 procedures. Results. Exclusion criteria, patient demographics, and indication for surgery were similar in both groups. The conversion rate was 0% in both groups. There were no intraoperative complications or deaths. Bowel recovery was similar in both groups. No interventions, readmissions, or deaths were recorded at 30 days’ follow-up. At a mean follow-up of 24 months, all the patients with a preoperative diagnosis of cancer are still alive and disease free. Considering the selected 3 items, the mean cost per patient for single-access laparoscopic surgery and multiple-access laparoscopic surgery were estimated as 7213 and 7495 Euros, respectively. Conclusion. We think that SALR could be performed in selected patients by surgeons with high multiport laparoscopic skills. It is compulsory by law to evaluate outcomes and cost-effectiveness by using randomized controlled trials.
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Affiliation(s)
- Umberto Bracale
- General and Mininvasive Surgical Unit, San Camillo Hospital, Trento, Italy
- Department of Surgical Specialities and Nephrology, University of Naples Federico II, Naples, Italy
| | - Paolo Melillo
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Second University of Naples, Naples, Italy
| | - Fabrizio Lazzara
- General and Mininvasive Surgical Unit, San Camillo Hospital, Trento, Italy
| | | | - Cesare Stabilini
- General and Mininvasive Surgical Unit, San Camillo Hospital, Trento, Italy
| | - Francesco Corcione
- General, Laparoscopic and Robotic Surgical Unit, Monaldi Hospital, Naples, Italy
| | - Giusto Pignata
- General and Mininvasive Surgical Unit, San Camillo Hospital, Trento, Italy
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Ohno Y. Role of the transumbilical laparoscopic-assisted single-channel, single-port procedure in an interval appendectomy for pediatric mass-forming appendicitis: a preliminary retrospective analysis. Asian J Endosc Surg 2014; 7:232-6. [PMID: 24861142 DOI: 10.1111/ases.12111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 03/06/2014] [Accepted: 04/06/2014] [Indexed: 12/26/2022]
Abstract
INTRODUCTION A transumbilical laparoscopic-assisted single-channel, single-port procedure was introduced during laparoscopic interval appendectomy for mass-forming appendicitis in children. The aim of this study was to evaluate the results of the original laparoscopic interval appendectomy. METHODS This study analyzed 31 children who underwent laparoscopic interval appendectomy using a single-channel, single-port procedure. The appendectomy was usually planned 8-12 weeks following initial conservative treatment. The procedure was a single-channel surgery using a 12-mm single port. Both a 5-mm telescope and grasper were inserted simultaneously into the single channel. The grasper held the appendix, and an extracorporeal appendectomy was performed. RESULTS Appendectomy was planned for 29 patients, as 2 patients deviated from the protocol. The procedure was successful in 21 patients (72.4%). An accessory port was necessary in eight patients, two of whom successfully underwent laparoscopic surgery; the remaining six were converted to open appendectomy. The average length of surgery was 43 min in the single-channel, single-port procedure. No postoperative complications occurred in any patient. CONCLUSION The single-channel, single-port procedure was successfully performed in over 70% of the patients. This preliminary retrospective analysis indicates that the procedure is safe and potentially beneficial in children with mass-forming appendicitis who require laparoscopic interval appendectomy.
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Affiliation(s)
- Yasuharu Ohno
- Department of Surgery, Oita Children's Hospital, Oita, Japan; Department of Pediatric Surgery, Saitama Medical University, Iruma, Japan
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Transumbilical Laparoscopic-assisted Versus 3-Port Laparoscopic and Open Appendectomy. Surg Laparosc Endosc Percutan Tech 2014; 24:244-7. [PMID: 24710220 DOI: 10.1097/sle.0b013e31828f6c16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lee CH, Jeon WJ, Youn SJ, Yun HY, Jang LC, Choi JW, Song YJ, Ryu DH. The experience of transumbilical endoscopic appendectomies. Ann Surg Treat Res 2014; 86:278-82. [PMID: 24851231 PMCID: PMC4024928 DOI: 10.4174/astr.2014.86.5.278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 12/23/2013] [Accepted: 12/24/2013] [Indexed: 12/21/2022] Open
Abstract
Minimally invasive surgery is being widely accepted in various fields of surgery. Although several appendectomy techniques have been reported but, there is no standardization. We report here the experiences of transumbilical endoscopic appendectomy in humans. Between July 2008 and September 2010, ten patients with appendicitis successfully underwent transumbilical endoscopic appendectomies. There were 7 cases of suppurative, 2 cases of gangrenous and 1 case of perforated in operative findings. The ages of the patients were 13-56 years (mean age, 32.7 ± 15.4 years). Under general anesthesia, a 15-mm port was inserted through the umbilicus and then a two-channel endoscope was inserted in the peritoneal cavity. After appendix identification, counter-traction of the appendix with a direct abdominal wall puncture using a straight round needle prolene was performed to achieve good visualization of the operative field. Tissue dissection was performed using an endoscopic needle knife. Tissue grasping and resected appendix retrieval were done with endoscopic forceps. The average operation time was 79.5 ± 23.6 minutes (range, 45 to 110 minutes). No procedures were converted to laparoscopic or open appendectomy. Hospital stay was 4-6 days. All patients completely recovered without complications. As it is highly maneuverable, we believe transumbilical endoscopic appendectomy can be a feasible method. And, as surgeons want to proceed from laparoscopic surgery to natural orifice transluminal endoscopic surgery, this procedure could be a triable method.
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Affiliation(s)
- Chung-Heon Lee
- Department of Surgery, Chungbuk National University College of Medicine, Medical Research Institute, Cheongju, Korea
| | - Won Joong Jeon
- Department of Internal Medicine, Chungbuk National University College of Medicine, Medical Research Institute, Cheongju, Korea
| | - Sei Jin Youn
- Department of Internal Medicine, Chungbuk National University College of Medicine, Medical Research Institute, Cheongju, Korea
| | - Hyo Young Yun
- Department of Surgery, Chungbuk National University College of Medicine, Medical Research Institute, Cheongju, Korea
| | - Lee-Chan Jang
- Department of Surgery, Chungbuk National University College of Medicine, Medical Research Institute, Cheongju, Korea
| | - Jae-Woon Choi
- Department of Surgery, Chungbuk National University College of Medicine, Medical Research Institute, Cheongju, Korea
| | - Young Jin Song
- Department of Surgery, Chungbuk National University College of Medicine, Medical Research Institute, Cheongju, Korea
| | - Dong Hee Ryu
- Department of Surgery, Chungbuk National University College of Medicine, Medical Research Institute, Cheongju, Korea
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Gorter RR, Heij HA, Eker HH, Kazemier G. Laparoscopic appendectomy: State of the art. Tailored approach to the application of laparoscopic appendectomy? Best Pract Res Clin Gastroenterol 2014; 28:211-24. [PMID: 24485267 DOI: 10.1016/j.bpg.2013.11.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 11/23/2013] [Indexed: 02/07/2023]
Abstract
Acute appendicitis is the most common surgical emergency in developed countries. The treatment of acute appendicitis is either open or laparoscopic appendectomy. The latter has gained wide acceptance in the past years, although the debate on the true merits of laparoscopic appendectomy is still on going. Some authors prefer this approach as the gold standard for all patients, but in our opinion a tailored approach is warranted for specific patient groups. In addition, a standardised guideline on the technical aspects is still lacking. In the current article, open versus laparoscopic appendectomy and several technical aspects, such as stump closure, appendix extraction and single incision are discussed laparoscopic appendectomy are being addressed. In the future perspectives we will briefly discuss the third 'newly' introduced antibiotic treatment.
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Affiliation(s)
- Ramon R Gorter
- Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands; Department of Surgery, Red Cross Hospital, Vondellaan13, 1942 LE Beverwijk, The Netherlands.
| | - Hugo A Heij
- Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
| | - Hasan H Eker
- Department of Surgery, Red Cross Hospital, Vondellaan13, 1942 LE Beverwijk, The Netherlands; Department of Surgery, VU University Medical Centre, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
| | - Geert Kazemier
- Department of Surgery, VU University Medical Centre, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
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Corcione F, Bracale U, Pirozzi F, Cuccurullo D, Angelini PL. Robotic single-access splenectomy using the Da Vinci Single-Site® platform: a case report. Int J Med Robot 2013; 10:103-6. [PMID: 24123571 DOI: 10.1002/rcs.1539] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Single-access laparoscopic splenectomy can offer patients some advantages. It has many difficulties, such as instrument clashing, lack of triangulation, odd angles and lack of space. The Da Vinci Single-Site® robotic surgery platform could decrease these difficulties. We present a case of single-access robotic splenectomy using this device. METHODS A 37 year-old female with idiopathic thrombocytopenic purpura was operated on with a single-site approach, using the Da Vinci Single-Site robotic surgery device. RESULTS The procedure was successfully completed in 140 min. No intraoperative and postoperative complications occurred. The patient was discharged from hospital on day 3. CONCLUSIONS Single-access robotic splenectomy seems to be feasible and safe using the new robotic single-access platform, which seems to overcome certain limits of previous robotic or conventional single-access laparoscopy. We think that additional studies should also be performed to explore the real cost-effectiveness of the platform.
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Affiliation(s)
- Francesco Corcione
- Department of Laparoscopic and Robotic Surgery, Monaldi Hospital, Naples, Italy
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Arezzo A, Zornig C, Mofid H, Fuchs KH, Breithaupt W, Noguera J, Kaehler G, Magdeburg R, Perretta S, Dallemagne B, Marescaux J, Copaescu C, Graur F, Szasz A, Forgione A, Pugliese R, Buess G, Bhattacharjee HK, Navarra G, Godina M, Shishin K, Morino M. The EURO-NOTES clinical registry for natural orifice transluminal endoscopic surgery: a 2-year activity report. Surg Endosc 2013; 27:3073-3084. [PMID: 23519494 DOI: 10.1007/s00464-013-2908-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 02/12/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND The EURO-NOTES Clinical Registry (ECR) was established as a European database to allow the monitoring and safe introduction of Natural Orifice Transluminal Endoscopic Surgery (NOTES). The aim of this study was to analyze different techniques applied and relative results during the first 2 years of the ECR. METHODS The ECR was designed as a voluntary database with online access. All members of the European Society for Gastrointestinal Endoscopy and the European Association for Endoscopic Surgery were requested to participate in the registry. Demographic and therapy data as well as data on the postoperative course are recorded in the ECR in an anonymous way. RESULTS A total of 533 patients who underwent NOTES procedures were included in the study. Four different hybrid techniques for 435 cholecystectomies were described, registering postoperative complications in 2.8% of patients, addition of a single trocar in 5.3%, and conversions to laparoscopy in 0.5%. Both flexible endoscopic and rigid laparoscopic cholecystectomy techniques proved to be safe and effective with minor differences. There was a shorter operative time in the rigid laparoscopic group. Thirty-three appendectomies were reported by transgastric and transvaginal techniques, with transvaginal techniques scoring shorter operative time and hospital stay, but with a frequent need to add more trocars. Overall complications occurred in 14.7% of patients but they did not differ significantly among the different techniques. One transvaginal and 31 transanal sigmoidectomies were included for prolapse and diverticulitis, with four postoperative complications (12.5%), but none needing further treatment. Twenty peroral esophageal myotomies were included with three postoperative complications (15.0%), but none needing further treatment. CONCLUSIONS Five years since the introduction of NOTES into clinical practice, hybrid techniques have gained considerable clinical application. Several NOTES hybrid cholecystectomy and appendectomy techniques are practicable and safe alternatives to laparoscopic procedures. Also, sigmoidectomies and peroral esophageal myotomies were described, proving feasibility and safety. Nevertheless, the real benefit of NOTES for patients still needs to be assessed.
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Affiliation(s)
- Alberto Arezzo
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy.
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Baik SM, Hong KS, Kim YI. A comparison of transumbilical single-port laparoscopic appendectomy and conventional three-port laparoscopic appendectomy: from the diagnosis to the hospital cost. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 85:68-74. [PMID: 23908963 PMCID: PMC3729989 DOI: 10.4174/jkss.2013.85.2.68] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/23/2013] [Accepted: 05/13/2013] [Indexed: 12/21/2022]
Abstract
Purpose Recently many cases of appendectomy have been conducted by single-incision laparoscopic technique. The aim of this study is to figure out the benefits of transumbilical single-port laparoscopic appendectomy (TULA) compared with conventional three-port laparoscopic appendectomy (CTLA). Methods From 2010 to 2012, 89 patients who were diagnosed as acute appendicitis and then underwent laparoscopic appendectomy a single surgeon were enrolled in this study and with their medical records were reviewed retrospectively. Cases of complicated appendicitis confirmed on imaging tools and patients over 3 points on the American Society of Anesthesia score were excluded. Results Among the total of 89 patients, there were 51 patients in the TULA group and 38 patients in the CTLA group. The visual analogue scale (VAS) of postoperative day (POD) #1 was higher in the TULA group than in the CTLA group (P = 0.048). The operative time and other variables had no statistical significances (P > 0.05). Conclusion Despite the insufficiency of instruments and the difficulty of handling, TULA was not worse in operative time, VAS after POD #2, and the total operative cost than CTLA. And, if there are no disadvantages of TULA, TULA may be suitable in substituting three-port laparoscopic surgery and could be considered as one field of natural orifice transluminal endoscopic surgery with the improvement and development of the instruments and revised studies.
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Affiliation(s)
- Seung Min Baik
- Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea
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15
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Li P, Chen ZH, Li QG, Qiao T, Tian YY, Wang DR. Safety and efficacy of single-incision laparoscopic surgery for appendectomies: A meta-analysis. World J Gastroenterol 2013; 19:4072-4082. [PMID: 23840155 PMCID: PMC3703197 DOI: 10.3748/wjg.v19.i25.4072] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/20/2013] [Accepted: 05/08/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare single incision laparoscopic surgery for an appendectomy (SILS-A) with conventional laparoscopic appendectomy (C-LA) when implemented by experienced surgeons.
METHODS: Studies and relevant literature regarding the performance of single-incision laparoscopic surgery vs conventional laparoscopic surgery for appendectomy were searched for in the Cochrane Central Register of Controlled Clinical Trials, MEDLINE, EMBASE and World Health Organization international trial register. The operation time (OR time), complications, wound infection and postoperative day using SILS-A or C-LA were pooled and compared using a meta-analysis. The risk ratios and mean differences were calculated with 95%CIs to evaluate the effect of SILS-A.
RESULTS: Sixteen recent studies including 1624 patients were included in this meta-analysis. These studies demonstrated that, compared with C-LA, SILS-A has a similar OR time in adults but needs a longer OR time in children. SILS-A has similar complications, wound infection and length of the postoperative day in adults and children, and required similar doses of narcotics in children, the pooled mean different of -0.14 [95%CI: -2.73-(-2.45), P > 0.05], the pooled mean different of 11.47 (95%CI: 10.84-12.09, P < 0.001), a pooled RR of 1.15 (95%CI: 0.72-1.83, P > 0.05), a pooled RR of 1.9 (95%CI: 0.92-3.91, P > 0.05), a pooled RR of 1.01 (95%CI: 0.51-2.0, P > 0.05) a pooled RR of 1.86 (95%CI: 0.77-4.48, P > 0.05), the pooled mean different of -0.25 (95%CI: -0.50-0, P = 0.05) the pooled mean different of -0.01 (95%CI: -0.05-0.04, P > 0.05) the pooled mean different of -0.13 (95%CI: -0.49-0.23, P > 0.05) respectively.
CONCLUSION: SILS-A is a technically feasible and reliable approach with short-term results similar to those obtained with the C-LA procedure.
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Chen YX, Zeng CY, Shu X, Zhou XJ, Ma JH, Lv NH. Use of natural orifice translumenal endoscopic surgery in the diagnosis of suspected tuberculous peritonitis: a retrospective case series of 7 patients. J Laparoendosc Adv Surg Tech A 2013; 23:610-6. [PMID: 23808847 DOI: 10.1089/lap.2013.0117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVE In cases of ascites of unknown etiology, tuberculosis peritonitis (TBP) is a possible cause but a diagnostic challenge. This retrospective case series assessed the effectiveness and safety of diagnostic natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and the Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) in 7 consecutive patients with suspected TBP. SUBJECTS AND METHODS Between September 2011 and August 2012, peritoneal biopsy was performed using transgastric NOTES for subsequent histology in 7 consecutive hospitalized patients who presented with ascites and were diagnosed with suspected TBP. The outcome measures included diagnostic accuracy and procedure-related morbidities. RESULTS Diagnostic NOTES was successfully completed in all 7 patients. Peritoneoscopy with NOTES went uneventfully and lasted 5-10 minutes. Typical peritoneal nodules characteristic of TBP were identified in all patients and confirmed pathologically as TBP. No clinically significant adverse events occurred in any patients following NOTES, except for 1 patient who experienced mild and transient pyrexia. Postoperative blood culture detected no microbial growth. Follow-up upper gastrointestinal endoscopy showed that the gastric wall wound healed well with minimal scarring. All patients were prescribed a standard four-drug antituberculosis chemotherapy regimen. The treatment outcomes were determined to be effective or curative, and no relapse was detected within the follow-up period. CONCLUSIONS NOTES is an effective and safe diagnostic technique in patients with suspected TBP presenting as ascites of unknown etiology.
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Affiliation(s)
- You-Xiang Chen
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China
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Kye BH, Lee J, Kim W, Kim D, Lee D. Comparative study between single-incision and three-port laparoscopic appendectomy: a prospective randomized trial. J Laparoendosc Adv Surg Tech A 2013; 23:431-6. [PMID: 23473061 DOI: 10.1089/lap.2012.0284] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Single-incision laparoscopic surgery is a new procedure used to treat a variety of diseases requiring surgical intervention. The aim of this prospective comparative study is to compare the technical feasibility and safety of single-incision and three-port laparoscopic appendectomy. STUDY DESIGN Between February 2009 and April 2010, 102 patients with appendicitis were enrolled in this study. The patients were randomly assigned to two groups: single-incision or three-port laparoscopic appendectomy. Patients with perforated appendicitis were not excluded. We analyzed the patients' clinical characteristics and surgical outcomes. RESULTS There were no significant differences in preoperative patient demographics between the two groups with respect to body mass index (22.03±4.07 kg/m(2) in the single-incision group versus 21.97±3.49 kg/m(2) in the three-port group, P=.930). The pain score on the visual analog scale on postoperative Day 1 was significantly lower in the single-incision group than in the three-port group (3.22±1.22 versus 3.90±1.46, P=.012). Additionally, recovery time to daily life was significantly shorter in the single-incision group than in the three-port group (3.22±1.04 versus 3.94±1.43 days, P=.005). In patients with perforated appendicitis, the single-incision procedure took approximately 10 minutes less than the three-port procedure (44.11±7.75 versus 54.14±32.21 minutes, P=.449), and the postoperative hospital stay (P=.033) and recovery time to daily life (P=.001) were significantly shorter in the single-incision group. CONCLUSIONS Single-incision laparoscopic appendectomy is a feasible and safe procedure, even in patients with perforated appendicitis, and this procedure is even less invasive than three-port laparoscopic surgical techniques.
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Affiliation(s)
- Bong-Hyeon Kye
- Department of Surgery, School of Medicine, The Catholic University of Korea, Seoul, Korea
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18
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Single-port laparoscopic appendectomy versus conventional laparoscopic appendectomy: a prospective randomized controlled study. Ann Surg 2013; 257:214-8. [PMID: 23241869 DOI: 10.1097/sla.0b013e318273bde4] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare surgical outcomes and quality of life between single-port laparoscopic appendectomy (SPLA) and conventional laparoscopic appendectomy (CLA) in patients with acute appendicitis. BACKGROUND A prospective randomized single center study was performed to compare the outcome of SPLA and CLA in patients with acute appendicitis. METHODS A total of 248 patients were randomized, but because of 18 withdrawals, the outcome of 224 is analyzed, 116 in CLA and 114 in SPLA. RESULTS There was no significant difference in the overall complication rate (P = 0.470). There were no significant differences in infectious complications between the SPLA group and the CLA group (10.2% and 12.4%, respectively). The wound complication rate between the 2 groups was not significant (5.1% and 10.6%, respectively; P = 0.207). Cosmetic satisfaction score, 36-item short-form health survey, and postoperative pain scores were not significantly different between 2 groups. CONCLUSIONS SPLA failed to show any advantages over CLA relative to pain and cosmesis. However, SPLA is as safe as CLA (RCT number 01348464).
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Dhumane P, Donatelli G, Chung H, Dallemagne B, Marescaux J. Feasibility of transumbilical flexible endoscopic preperitoneoscopy (FLEPP) and its utility for inguinal hernia repair: experimental animal study. Surg Innov 2013; 20:5-12. [PMID: 22956400 DOI: 10.1177/1553350612458727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND STUDY AIMS Various NOTES (natural orifice translumenal endoscopic surgery) hernia repair techniques have been described. The aim of this study was to evaluate the feasibility of a transumibilically introduced conventional double-channel flexible endoscope for performing preperitoneoscopy (FLEPP, flexible endoscopic preperitoneoscopy technique) and to perform totally extraperitoneal (TEP) inguinal hernia meshplasty in an animal model. MATERIAL AND METHODS The study was done in 2 steps on 8 swines weighing 25 to 30 kg each: (1) establishing feasibility of preperitoneal dissection of the inguinal region using a conventional double-channel flexible gastroscope and making bed for mesh placement and (2) placement of a polypropylene mesh in the inguinal region to cover the myopectineal orifice. RESULTS The flexible endoscope provided good vision and maneuverability to identify preperitoneal structures--namely, the arcuate line, insertion of rectus abdominis on pubis symphysis, inferior epigastric vessels, deep inguinal ring, spermatic cord, pubic symphysis, and psoas muscle--without causing any damage to any of the structures. The spermatic cord could be dissected to identify the vas deference. A 9 × 7 cm(2) oval mesh was successfully placed over the myopectineal orifice of Fruchaud with good overlap. Average time required for the complete FLEPP procedure (including mesh placement) was 55 minutes (range 45-90 minutes). CONCLUSIONS This study demonstrates, for the first time, the feasibility of the transumbilical FLEPP technique and its utility for performing TEP inguinal hernia repair with prosthetic mesh placement in a swine model.
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Affiliation(s)
- Parag Dhumane
- Department of Gastrointestinal and Endocrinal Surgery, University of Strasbourg, Strasbourg, France.
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Rehman H, Mathews T, Ahmed I. A review of minimally invasive single-port/incision laparoscopic appendectomy. J Laparoendosc Adv Surg Tech A 2013; 22:641-6. [PMID: 22954028 DOI: 10.1089/lap.2011.0237] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Single-port/incision laparoscopic appendectomy (SPILA) is a modern advancement toward stealth surgery, using a single point of entry. Despite the paucity of clinical data, it is increasingly being used to minimize scarring and, potentially, pain associated with the multiple entry points. We aimed to summarize and present available data on this new approach. METHODOLOGY All available databases until December 2010 including the Cochrane Controlled Trials Register, MEDLINE, and EMBASE were searched and cross-referenced for studies describing single-incision laparoscopic appendectomy. Case and experimental reports, series with fewer than 5 patients, and non-English articles were excluded. Outcome measures were operative time, postoperative hospital stay, pain scores, complications, conversion, and mortality, stratified according to type of SPILA approach. SPSS version 18.0.0 software was used for data collection. RESULTS Database query yielded 79 articles; 45 were included (1 randomized controlled trial, 44 case series). Total cases were 2806, with mean patient age for studies ranging from 7.0 to 37.5 years. No mortality was reported. The overall complication rate was 4.13%. The overall weighted mean operating time was 41.3 minutes (range, 15.0-95.9 minutes). The weighted mean hospital stay was 2.79 days (range, 1.0-6.6 days). CONCLUSIONS Although the incidence of complications with SPILA remains low and operating times between new and traditional approaches are comparable in case-based literature, adequately powered randomized trials are required to assess its effectiveness. Occurrence of long-term complication types remains unexplored.
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Affiliation(s)
- Haroon Rehman
- University of Aberdeen, Aberdeen, Scotland, United Kingdom.
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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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The need for training frameworks and scientific evidence in developing scarless surgery: A national survey of surgeons' opinions on single port laparoscopic surgery. Int J Surg 2013; 11:73-6. [DOI: 10.1016/j.ijsu.2012.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 10/22/2012] [Accepted: 11/27/2012] [Indexed: 11/21/2022]
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Single-port laparoscopic surgery of the distal esophagus: initial clinical experience. Surg Laparosc Endosc Percutan Tech 2012; 22:e118-21. [PMID: 22678329 DOI: 10.1097/sle.0b013e318247c45f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Laparoscopic fundoplication (LF) is considered to be potentially suitable for single-port surgery because of lack of requirements of organ resection, anastomosis, and specimen retrieval. However, its feasibility and safety have not been fully established. The objective of this study was to evaluate the feasibility and safety of single-port LF (sLF) in our institution. sLF was attempted in 11 patients and was completed without the additional ports in 3 patients (27%). The remaining 8 patients required the addition of 1 to 3 ports to complete LF. Median operating time and blood loss were 221 minutes and 20 mL, respectively (intention-to-treat). No major complications were noted. All patients showed uneventful postoperative recovery and clinical improvement of their preoperative symptoms with satisfactory cosmetic outcome. sLF is technically feasible and safe, although the use of extra ports should be positively considered to ensure the safety and quality of LP.
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Gumus II, Surgit O, Kaygusuz I. Laparoscopic single-port Burch colposuspension with an extraperitoneal approach and standard instruments for stress urinary incontinence: early results from a series of 15 patients. MINIM INVASIV THER 2012; 22:116-21. [PMID: 22909022 DOI: 10.3109/13645706.2012.711759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We aimed to investigate the use of single-port laparoscopy in a series of patients undergoing Burch colposuspension with an extraperitoneal approach as an alternative treatment for scarless surgery in stress urinary incontinence. MATERIAL AND METHODS From September 2010 to May 2011 we performed single-port extraperitoneal laparoscopic Burch colposuspension for stress incontinence in 15 patients. Fifteen women who were diagnosed with urodynamic stress incontinence were included in the study. Demographic and clinical data, intraoperative findings, and postoperative course were recorded. RESULTS The mean age was 45,80 ± 9,91 years (range: 38-70 years). The mean body mass index was 25,67 ± 4.06 kg/m2 (range: 22.23-35.38 kg/m(2)). The mean operation time and mean blood loss were 40.80 ± 5.94 minutes (range: 30-50 minutes) and 30.67 ± 11.00 cc (range: 10-50 cc), respectively. The single-port laparoscopic operations were technically completed successfully without placement of additional trocars and there were no complications. The cure and improvement rates following laparoscopic Burch colposuspension via single port were 73.3 % and 20 % respectively. CONCLUSION Single-port laparoscopic Burch can be an alternative treatment for scarless surgery in stress incontinence. Single-incision laparoscopic Burch colposuspension can offer suitable, effective and safe treatment in women with stress incontinence.
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Affiliation(s)
- Ilknur Inegol Gumus
- Department of Obstetric and Gynecology, Fatih University Medical School, Ankara, Turkey.
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Single-port endo-laparoscopic surgery (SPES) for totally extraperitoneal inguinal hernia: a critical appraisal of the chopstick repair. Hernia 2012; 17:217-21. [PMID: 22829008 DOI: 10.1007/s10029-012-0968-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 07/12/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Developments in minimal access surgery brought a new concept: single-port endolaparoscopic surgery (SPES). The aim of our study is to verify the safety and feasibility of SPES TEP hernia repair and report our initial clinical outcome. METHODS We prospectively collected data of all patients who underwent SPES TEP repair from May 2009 to December 2010. Data regarding patient demographics, type, size and location of hernia, port devices used, type of mesh and fixation, operative time, complications, length of stay and cosmetic results were collected and analyzed. RESULTS A total of 47 patients (36 M, 11 F) underwent 70 SPES TEP hernia repairs; median age was 53 years (range 22-80). 60 % had indirect hernia, 27.5 % direct, 8.5 % pantaloon, 2 % femoral and 2 % recurrent hernias. Mean hernia size was 1.91 ± 0.67 cm. Port devices used include 33 Triport, 12 SILS and 2 SSL. We used anatomical mesh in 20; flat polypropylene in 10 and titanium-coated polypropylene mesh in 17 patients. Fixation of mesh was achieved in 18 patients with absorbable tacks, 8 with titanium tacks, 1 with fibrin glue, and no tack in 20 with anatomical mesh. No conversions occurred and small seroma was reported in 3 (6.3 %) patients. Mean operative time was 96.48 min (range: 50-150). Average hospital stay was 11.8 h (range: 9-26). Median follow-up was 11 months (range 6-18), and no recurrence was noted. 82.6 % patients were very satisfied, and 17.4 % were satisfied with the procedure. CONCLUSION SPES TEP repair is a safe and feasible technique with good patient satisfaction.
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Park K, Afthinos JN, Lee D, Koshy N, McGinty JJ, Teixeira JA. Single port sleeve gastrectomy: strategic use of technology to re-establish fundamental tenets of multiport laparoscopy. Surg Obes Relat Dis 2012; 8:450-7. [DOI: 10.1016/j.soard.2011.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 05/31/2011] [Accepted: 06/06/2011] [Indexed: 12/19/2022]
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Single-incision laparoscopic appendectomy: prospective case series at a single centre in Singapore. Surg Laparosc Endosc Percutan Tech 2012; 21:318-21. [PMID: 22002266 DOI: 10.1097/sle.0b013e3182311bd9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Laparoscopic appendectomy is widely accepted as a standard of care for acute appendicitis. Aim of our study is to assess the safety and feasibility of single-incision laparoscopic appendectomy (SILA) in our hospital setting. METHODS From March to August 2010, 30 patients (21 male, 9 female) with mean age 30.4 years (range, 17 to 64 y) with clinical diagnosis of acute appendicitis underwent SILA. RESULTS The procedure was successful in 28 of 30 patients. Mean operative time was 80.4 minutes (range, 31 to 136 min). There was no mortality or major postoperative complication. The median hospital stay was 1.9 days (range, 1 to 5 d). The mean visual analogue scale score at the time of discharge was 2.2 (range, 1 to 4). CONCLUSIONS In our early experience, SILA is safe and feasible, with acceptable operative time, short learning curve, and good cosmetic result.
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Rehman H, Ahmed I. Technical approaches to single port/incision laparoscopic appendicectomy: a literature review. Ann R Coll Surg Engl 2011; 93:508-13. [PMID: 22004632 PMCID: PMC3604919 DOI: 10.1308/147870811x13137608455091] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2011] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Single port/incision laparoscopic surgery (SPILS) is a modern advancement toward stealth surgery. Despite the paucity of high-quality scientific studies assessing its effectiveness, this procedure is being used increasingly. This review aims to describe commonly used techniques for SPILS appendicectomies (SPILA), to summarise complication rates in the literature and to provide discussion on indications and implementation. METHODS All available databases including the Cochrane Central Register of Controlled Trials, MEDLINE(®) and Embase™ were searched in February 2011 and cross-referenced for available English literature describing SPILA in patients of any age. RESULTS Three broad technical approaches are described: procedures using laparoscopic instruments through a single skin incision in the abdominal wall, regardless of the number of fascial incisions, with or without the additional use of percutaneous sutures or wires to 'assist' the operation, and hybrid procedures, in which the appendix is exteriorised using a single incision laparoscopically assisted operation but subsequently divided using a conventional 'open' appendicectomy technique. Complication rates seem to be highest in SPILA procedures unassisted by sutures or wires. CONCLUSIONS Future research assessing the efficacy of single incision laparoscopic procedures should consider variation in technique as a possible factor affecting outcome.
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Affiliation(s)
- H Rehman
- Department of Hepatopancreatobiliary Surgery, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK.
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Ohno Y, Morimura T, Hayashi SI. Transumbilical laparoscopically assisted appendectomy in children: the results of a single-port, single-channel procedure. Surg Endosc 2011; 26:523-7. [PMID: 21938576 DOI: 10.1007/s00464-011-1912-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 07/20/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Even for pediatric patients, the use of laparoscopic appendectomy has been widely accepted, and three trocars usually are necessary to perform a laparoscopic appendectomy. However, single-port appendectomy for children represents an attractive alternative. To reduce the number of incisions and trocars, the authors have adopted a transumbilical laparoscopically assisted single-port appendectomy (TULAA) approach. This study aimed to evaluate the results of their single-channel, single-port appendectomy. METHODS A retrospective study of TULAA was performed during 12 years with 500 children ages 2-16 years (median, 10.2 years). The TULAA approach is a single-channel surgery using a 12 mm conventional single-port. The vertical incision through the umbilicus is used for laparoscopic access. Two laparoscopic instruments, a 5 mm telescope and a 5 mm grasper, are inserted simultaneously into the single-channel. The grasper holds the base of the appendix, and the appendix is exteriorized through the umbilical incision. Thereafter, a conventional appendectomy is performed extracorporeally. RESULTS The TULAA procedure was successful for 416 patients (83.2%). These successful TULAA procedures required a mean surgery time of 44.5 min. The pathologic diagnosis of the appendix was acute for 59 patients, phlegmonous for 203 patients, gangrenous for 152 patients, and not detected for two patients. Complications occurred for 47 of these patients (11.3%). Most of the complications were associated with severe intraabdominal inflammation. Two patients needed reoperation under general anesthesia. Conversion to multitrocar surgery or open appendectomy was performed for 84 of the patients (16.8%). CONCLUSIONS The TULAA procedure is a preferable operation for acute appendicitis in children because it is simple and provides good cosmetic results.
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Affiliation(s)
- Yasuharu Ohno
- Department of Pediatric Surgery, Saitama Medical University, 38 Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan.
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Rao PP, Rao PP, Bhagwat S. Single-incision laparoscopic surgery - current status and controversies. J Minim Access Surg 2011; 7:6-16. [PMID: 21197236 PMCID: PMC3002008 DOI: 10.4103/0972-9941.72360] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Accepted: 09/20/2010] [Indexed: 12/15/2022] Open
Abstract
Scarless surgery is the Holy Grail of surgery and the very raison d’etre of Minimal Access Surgery was the reduction of scars and thereby pain and suffering of the patients. The work of Muhe and Mouret in the late 80s, paved the way for mainstream laparoscopic procedures and it rapidly became the method of choice for many intra-abdominal procedures. Single-incision laparoscopic surgery is a very exciting new modality in the field of minimal access surgery which works for further reducing the scars of standard laparoscopy and towards scarless surgery. Natural orifice translumenal endoscopic surgery (NOTES) was developed for scarless surgery, but did not gain popularity due to a variety of reasons. NOTES stands for natural orifice translumenal endoscopic surgery, a term coined by a consortium in 2005. NOTES remains a research technique with only a few clinical cases having been reported. The lack of success of NOTES seems to have spurred on the interest in single-incision laparoscopy as an eminently doable technique in the present with minimum visible scarring, rendering a ‘scarless’ effect. Laparo-endoscopic single-site surgery (LESS) is, a term coined by a multidisciplinary consortium in 2008 for single-incision laparoscopic surgery. These are complementary technologies with similar difficulties of access, lack of triangulation and inadequate instrumentation as of date. LESS seems to offer an advantage to surgeons with its familiar field of view and instruments similar to those used in conventional laparoscopy. LESS remains a evolving special technique used successfully in many a centre, but with a significant way to go before it becomes mainstream. It currently stands between standard laparoscopy and NOTES in the armamentarium of minimal access surgery. This article outlines the development of LESS giving an overview of all the techniques and devices available and likely to be available in the future.
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Affiliation(s)
- Prashanth P Rao
- Department of Minimally Invasive Surgery, Mamata Hospital, Dombivli, Mumbai, India
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Rehman H, Rao AM, Ahmed I. Single incision versus conventional multi-incision appendicectomy for suspected appendicitis. Cochrane Database Syst Rev 2011:CD009022. [PMID: 21735437 DOI: 10.1002/14651858.cd009022.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Appendicectomy is a well established surgical procedure used in the management of acute appendicitis. The operation can be performed with minimally invasive surgery (laparoscopic) or as an open procedure. A recent development in appendicectomy has been the introduction of less invasive single incision laparoscopic surgery, using a single multi-luminal port or multiple mono-luminal ports, through a single skin incision. There are yet unanswered questions regarding the efficacy of this new and novel technique including: patient benefit and satisfaction, complications, long-term outcomes, and survival. OBJECTIVES The aim of this review is to perform meta-analysis using data from available trials comparing single incision with conventional multi-incision laparoscopic appendicectomy for appendicitis, in order to ascertain any differences in outcome. SEARCH STRATEGY We searched the electronic databases including MEDLINE/PubMed (from 1980 to December 2010), EMBASE/Ovid (from 1980 to December 2010) and CENTRAL (The Cochrane Library 2010, Issue 11) with pre-specified terms. We also searched reference lists of relevant articles and reviews, conference proceedings and ongoing trial databases. SELECTION CRITERIA Randomised or quasi-randomised controlled trials of patients with appendicitis, or symptoms of appendicitis, undergoing laparoscopic appendicectomy, in which at least one arm involves single incision procedures and another multi-incision procedures. DATA COLLECTION AND ANALYSIS There were no RCTs or prospectively controlled trials found that met the inclusion criteria. MAIN RESULTS Three authors performed study selection independently.No studies that met the inclusion criteria of this review were identified. Current evidence exists only the form of case-series.This review has been authored as 'empty' pending the results of 5 ongoing trials. AUTHORS' CONCLUSIONS No RCTs comparing single incision laparoscopic appendectomy with multi-incision surgery could be identified. No definitive conclusions can be made at this time. Well designed prospective RCTs are required in order to evaluate benefit or harm from laparoscopic surgical approaches for appendicectomy. Until appropriate data has been reported, the institutional polices of healthcare providers must be based on the clinical judgement of experts in the field.
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Affiliation(s)
- Haroon Rehman
- General Surgery, University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, UK, AB25 2ZD
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Jung MH, Lee BY. Transumbilical single-port laparoscopic-assisted vaginal hysterectomy via 12-mm trocar incision site. J Laparoendosc Adv Surg Tech A 2011; 21:599-602. [PMID: 21612446 DOI: 10.1089/lap.2010.0396] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Single-port laparoscopic-assisted vaginal hysterectomy (S-LAVH) uses only one transumbilical incision site and has better cosmetic result than conventional multiport LAVH. This study aimed to evaluate our initial experience with S-LAVH compared with the more conventional three-port LAVH in women with benign uterine diseases. METHODS Between April 2009 and April 2010, S-LAVH was attempted on 183 patients with benign uterine diseases through a transumbilical incision for a 12-mm trocar, and conventional LAVH was performed on 275 patients by the same surgeon. The medical records of patients were reviewed. The age, body mass index, operative time, blood loss, and uterine weight on pathologic report were compared. RESULTS Two of 183 patients in the S-LAVH group were converted to two- or three-port surgery, compared with none in the conventional group. Data analysis was done for 181 patients in the S-LAVH group and 275 patients in the conventional LAVH group. No major complications, including ureteral or bladder injuries, occurred in any of the patients. No statistically significant differences were found in mean age, mean body mass index, mean operative time, mean anesthesia time, mean estimated blood loss, or mean postoperative days to passage of flatus, but the mean uterine weights on the pathologic reports were significantly reduced in the S-LAVH group. CONCLUSION S-LAVH could be a feasible alternative method for removal of the uterus with a better cosmetic outcome resulting from single wound in selected patients. For patients with large-sized uterus, more surgical experience and improvement in instruments suitable for S-LAVH are needed.
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Affiliation(s)
- Min Hyung Jung
- Department of Obstetrics and Gynecology, School of Medicine, Kyung Hee University, Kyung Hee Medical Center, Seoul, Korea.
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Single incision versus conventional multi-incision appendectomy for suspected appendicitis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.cd009022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Ahmed K, Wang TT, Patel VM, Nagpal K, Clark J, Ali M, Deeba S, Ashrafian H, Darzi A, Athanasiou T, Paraskeva P. The role of single-incision laparoscopic surgery in abdominal and pelvic surgery: a systematic review. Surg Endosc 2011; 25:378-96. [PMID: 20623239 DOI: 10.1007/s00464-010-1208-6] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Accepted: 04/09/2010] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This review aimed to determine the role of single-incision laparoscopic surgery (SILS) in abdominal and pelvic operations. DATA SOURCES The Medline, EMBASE, and PsycINFO databases were systematically searched until October 2009 using "single-incision laparoscopic surgery" and related terms as keywords. References from retrieved articles were reviewed to broaden the search STUDY SELECTION The study included case reports, case series, and empirical studies that reported SILS in abdominal and pelvic operations. DATA EXTRACTION Number of patients, type of instruments, operative time, blood loss, conversion rate, length of hospital stay, length of follow-up evaluation, and complications were extracted from the reviewed items DATA SYNTHESIS The review included 102 studies classified as level 4 evidence. Most of these studies investigated SILS in cholecystectomy (n=34), appendectomy (n=24), and nephrectomy (n=17). For these procedures, operative time, hospital stay, and complications were comparable with those of conventional laparoscopy. Conversion to conventional laparoscopy was seldom performed in cholecystectomy (range, 0-24%) and more frequent in appendectomy (range, 0-41%) and nephrectomy (range, 0-33%). CONCLUSION The potential benefits of SILS include superior cosmesis and possibly shorter operative time, lower costs, and a shortened time to full physical recovery. Careful case selection and a low threshold of conversion to conventional laparoscopic surgery are essential. Multicenter, randomized, prospective studies are needed to compare short- and long-term outcome measures against those of conventional laparoscopic surgery.
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Affiliation(s)
- Kamran Ahmed
- Department of Biosurgery and Surgical Technology, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital Campus, Praed Street, London, W2 1NY, UK.
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Single-incision Laparoscopic Surgery (SILS) in general surgery: a review of current practice. Surg Laparosc Endosc Percutan Tech 2011; 20:191-204. [PMID: 20729685 DOI: 10.1097/sle.0b013e3181ed86c6] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Single-incision laparoscopic surgery (SILS) aims to eliminate multiple port incisions. Although general operative principles of SILS are similar to conventional laparoscopic surgery, operative techniques are not standardized. This review aims to evaluate the current use of SILS published in the literature by examining the types of operations performed, techniques employed, and relevant complications and morbidity. This review considered a total of 94 studies reporting 1889 patients evaluating 17 different general surgical operations. There were 8 different access techniques reported using conventional laparoscopic instruments and specifically designed SILS ports. There is extensive heterogeneity associated with operating methods and in particular ways of overcoming problems with retraction and instrumentation. Published complications, morbidity, and hospital length of stay are comparable to conventional laparoscopy. Although SILS provides excellent cosmetic results and morbidity seems similar to conventional laparoscopy, larger randomized controlled trials are needed to assess the safety and efficacy of this novel technique.
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Saber AA, El-Ghazaly TH, Elain A, Dewoolkar AV. Single-Incision Laparoscopic Placement of an Adjustable Gastric Band versus Conventional Multiport Laparoscopic Gastric Banding: A Comparative Study. Am Surg 2010. [DOI: 10.1177/000313481007601215] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Single-incision laparoscopic surgery (SILS™) is rapidly becoming the focal point of attraction for early adopters of minimally invasive surgery nationwide. Having achieved a rapid crossover to the realm of advanced surgical procedures, SILS™ has shown remarkable versatility and adaptability, making it no longer limited to basic laparoscopic procedures. We report our experience performing laparoscopic placement of gastric bands with an emphasis on comparison of the single-incision laparoscopic approach with the conventional multiport laparoscopic approach. From December 2008 to September 2009, 27 patients underwent laparoscopic placement of an adjustable gastric band at Michigan State University/Kalamazoo Center for Medical Studies. This included 15 patients who underwent single-incision laparoscopic gastric banding and 12 patients who underwent conventional multiport laparoscopic gastric banding procedures. The overall pain score was found to be significantly less in the SILS group than that for the conventional multiport laparoscopic gastric banding group with a statistically significant P value of 0.012. The operating time was found to be significantly less in the multiport group with a P value of 0.000. Differences in immediate postoperative pain scores, analgesia, and the overall length of hospital stay were found to be statistically insignificant. Single-incision laparoscopic gastric banding is associated with significantly less overall postoperative pain than the conventional laparoscopic approach; in addition, it provides improved cosmetic outcome despite a modest increase in operative time.
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Affiliation(s)
- Alan A. Saber
- Department of Surgery, Case Western Reserve University Hospital, Cleveland, Ohio
| | - Tarek H. El-Ghazaly
- General Surgery, Michigan State University, Kalamazoo Center for Medical Studies, Kalamazoo, Michigan
| | - Alain Elain
- General Surgery, Michigan State University, Kalamazoo Center for Medical Studies, Kalamazoo, Michigan
| | - Aditya V. Dewoolkar
- General Surgery, Michigan State University, Kalamazoo Center for Medical Studies, Kalamazoo, Michigan
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Saber AA, El-Ghazaly TH, Dewoolkar AV, Slayton SA. Single-incision laparoscopic sleeve gastrectomy versus conventional multiport laparoscopic sleeve gastrectomy: technical considerations and strategic modifications. Surg Obes Relat Dis 2010; 6:658-64. [DOI: 10.1016/j.soard.2010.03.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 02/08/2010] [Accepted: 03/03/2010] [Indexed: 01/01/2023]
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Laparoscopic transumbilical single-port appendectomy: initial experience and comparison with three-port appendectomy. Surg Laparosc Endosc Percutan Tech 2010; 20:100-3. [PMID: 20393336 DOI: 10.1097/sle.0b013e3181d84922] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Laparoscopic appendectomy usually needs 3 ports, 1 for the videoscope and 2 as working channels. The aim of this study was to compare the feasibility and postoperative outcomes of laparoscopic transumbilical single-port appendectomy with conventional three-port appendectomy. METHODS From October 2008 to January 2009, 35 patients underwent single-port appendectomy (SA). Surgical outcomes such as operation time, number of times of parenteral analgesic injected, complication, and hospital stay of 35 patients receiving SA were analyzed and compared with those of 37 patients receiving three-port appendectomy (TA) during the same period. RESULTS Comparing SA with TA, there were no statistically significant differences in operation time (75.9+/-27.4 vs. 66.4+/-21.7 min), times of injected analgesic (0.86+/-1.3 vs. 0.97+/-1.47 times), complication rate (8.6% vs. 2.7%), and hospital stay (3.0+/-1.3 vs. 3.2+/-1.4 d). The most common complication was wound infection (2 cases for SA and 1 for TA). One instance of intra-abdominal fluid accumulation occurred in a patient with perforated appendicitis during SA, and this was managed with image-guided drainage. In contrast to the TA, the abdominal scar in SA was nearly inconspicuous. CONCLUSIONS This study showed SA to be feasible, and it did not show any difference in postoperative outcomes compared with TA. Moreover, SA can produce scarless surgery without the need for specialized instrumentation.
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Chouillard E, Dache A, Torcivia A, Helmy N, Ruseykin I, Gumbs A. Single-incision laparoscopic appendectomy for acute appendicitis: a preliminary experience. Surg Endosc 2010; 24:1861-1865. [PMID: 20108149 DOI: 10.1007/s00464-009-0860-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 08/15/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND Natural orifice translumenal endoscopic surgery (NOTES) is a major conceptual change in the field of modern surgery. However, corresponding technological refinements are not yet available to fill the gap separating the current laparoscopy from the NOTES of the future. Meanwhile, "hybrid" NOTES techniques, including single-port procedures, have been increasingly reported. This report describes a technique of single-incision laparoscopic appendectomy (SILA) for selected patients with acute appendicitis. METHODS Patients with noncomplicated acute appendicitis, excluding those with abscess, perforation, peritonitis, previous surgery, or obesity, underwent SILA. The procedure was performed using a single 15-mm-diameter umbilical incision with two 5-mm-diameter port sites. RESULTS The study enrolled 36 women and 19 men with a mean age of 28 years (range, 18-78 years). The procedure was achieved for 41 patients (74.5%). The mean operative time was 39 min (range, 14-111 min). There was no mortality. The postoperative complication rate was 5.4% (3 complications in 3 patients), and the median hospital stay was 39 h (range, 8-240 h). CONCLUSION The SILA technique is safe and feasible for selected patients with noncomplicated acute appendicitis. Compared with other transumbilical techniques of appendectomy, SILA has the advantages of feasibility without endoscopic skills and an acceptable operative time. Technical refinements and accomplished learning probably will enable its wider use for more patients with acute appendicitis.
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Affiliation(s)
- Elie Chouillard
- Department of General and Minimally Invasive Surgery, Centre Hospitalier, 10 rue du Champ Gaillard, 78300 Poissy, France.
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Saber AA, El-Ghazaly TH. Single-Incision Transumbilical Laparoscopic Splenic Cyst Unroofing: First Reported Case. Am Surg 2010. [DOI: 10.1177/000313481007600519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Single-incision laparoscopic surgery is an emerging minimally invasive approach. When using the single-incision laparoscopic surgery approach, the surgeon operates almost exclusively through a single point of entry, usually the patient's umbilicus. This approach is steadily gaining popularity among minimally invasive surgeons, as it combines the cosmetic advantage of Natural Orifice Translumenal Surgery with the technical familiarity of conventional laparoscopic surgery. In this report, we describe our implementation of the single-incision laparoscopic approach to perform an unroofing of a posttraumatic splenic cyst; in this case, the entire procedure is performed through a 2-cm intraumbilical incision.
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Affiliation(s)
- Alan A. Saber
- Case Western Reserve University, Cleveland Ohio, and Kalamazoo, Michigan
| | - Tarek H. El-Ghazaly
- Michigan State University, Kalamazoo Center for Medical Studies, Kalamazoo, Michigan
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Saber AA, El-Ghazaly TH. Feasibility of Single-Access Laparoscopic Sleeve Gastrectomy in Super-Super Obese Patients. Surg Innov 2010; 17:36-40. [DOI: 10.1177/1553350610361895] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: The sleeve gastrectomy procedure has been gaining popularity because of its simplicity and favorable outcomes. This study reports the experience with a single-access approach to laparoscopic sleeve gastrectomy in super-super obese patients. Methods: Four super-super obese patients having a mean body mass index of 62.7 kg/m2 underwent single-access laparoscopic sleeve gastrectomy. The same perioperative protocol and operative techniques were implemented for all 4 patients. Results: A total of 4 single-access laparoscopic sleeve gastrectomies in super-super obese patients were successfully performed using this technique. Mean operating time was 126 minutes. One patient required the insertion of an additional trocar. There were no mortalities or postoperative complications noted. Most comorbidities either improved or resolved during a mean follow-up of 5.3 months. Conclusion: Single-access laparoscopic sleeve gastrectomy in the super-super obese is safe, feasible, and reproducible.
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de Campos Martins MVD, Skinovsky J, Coelho DE, Ramos A, Galvão Neto MP, Rodrigues J, de Carli L, Totti Cavazolla L, Campos J, Thuller F, Brunetti A. Cholecystectomy by Single Trocar Access (SITRACC): The First Multicenter Study. Surg Innov 2009; 16:313-6. [DOI: 10.1177/1553350609353422] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The advent of endoscopic surgery has radically changed surgery worldwide.The concept of minimally invasive procedures has spread quickly, allowing less pain and more rapid recovery for patients. The authors have developed a device for a new surgical approach, the so-called single trocar access (SITRACC). This study report the first multicenter study of cholecystectomies performed with SITRACC. Methods: Between December 2008 and June 2009, 81 single trocar cholecystectomies were performed in 9 Brazilian surgery centers. Results: The average operative time was 68 minutes. In all, 10 surgeries required 1 additional trocar because of technical problems, and 3 cholecystectomies were converted to standard video laparoscopies. Conclusion: A cholecystectomy using the SITRACC method is feasible and safe.
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Saber AA, El-Ghazaly TH, Minnick DB. Single port access transumbilical laparoscopic Roux-en-Y gastric bypass using the SILS Port: first reported case. Surg Innov 2009; 16:343-7. [PMID: 20031939 DOI: 10.1177/1553350609354604] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The emergence of natural orifice translumenal endoscopic surgery (NOTES) has brought significantly more attention to the single-incision transumbilical laparoscopic approach (SILS) for minimally invasive surgery. SILS combines the cosmetic advantage of NOTES with the technical familiarity of the conventional multiport laparoscopic approach. Additionally, SILS does not involve penetration of an organ, nor does it involve the steep learning curve and costly instruments associated with NOTES. Given these advantages, the authors believe that the single-incision transumbilical approach highlights the future direction of minimally invasive surgery. However, because of the associated technical challenges, the single-incision approach has not quite yet achieved the crossover to advanced surgical procedures that conventional multiport laparoscopy achieved in its early years. In this report, the authors present what is, to the best of their knowledge, the first reported case of a single-port access laparoscopic Roux-en-Y gastric bypass using the SILS Port placed through a single intraumbilical skin incision.
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Affiliation(s)
- Alan A Saber
- Kalamazoo Center for Medical Studies, Michigan State University, Kalamazoo, MI 49008, USA.
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Saber AA, Elgamal MH, El-Ghazaly TH, Dewoolkar AV, Akl A. Simple technique for single incision transumbilical laparoscopic appendectomy. Int J Surg 2009; 8:128-30. [PMID: 20005314 DOI: 10.1016/j.ijsu.2009.12.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 11/14/2009] [Accepted: 12/01/2009] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Acute appendicitis is one of the most commonly encountered surgical problems in everyday practice. With the recent increase in popularity of single incision laparoscopic surgery (SILS), several techniques for SILS appendectomy have already been described. We herein describe our own simplified technique for single incision transumbilical laparoscopic appendectomy. MATERIALS AND METHODS From December 2008 to August 2009, a total of 26 patients consented for single incision laparoscopic appendectomy for acute appendicitis. Preoperative, intraoperative and postoperative data were collected. RESULTS Our technique was successful in 19 out of 26 (73.1%) patients, while seven patients required the placement of additional trocars. None of the patients needed conversion to an open approach. Mean OR time was 45.9 min. The mean length of stay was 1.1 day. Only one patient had developed postoperative umbilical wound infection. CONCLUSION Our technique for single incision laparoscopic transumbilical appendectomy is safe feasible, and reproducible. Prospective randomized studies comparing the single incision laparoscopic approach with its conventional multiport counterpart are necessary to confirm the conclusions of our early experience.
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Affiliation(s)
- Alan A Saber
- Case Western Reserve University, 11100 Euclide Ave, Cleveland, OH 44106, USA.
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Lukovich P. [NOTES (Natural Orifice Translumenal Endoscopic Surgery)]. Magy Seb 2009; 62:274-278. [PMID: 19679539 DOI: 10.1556/maseb.62.2009.4.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Lázár G. [Abdominal catastrophe]. Magy Seb 2009; 62:265-273. [PMID: 19679538 DOI: 10.1556/maseb.62.2009.4.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- György Lázár
- Szegedi Tudományegyetem Szent-Györgyi Albert Klinikai Központ Sebészeti Klinika Szeged
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Saber AA, El-Ghazaly TH. Early experience with single incision transumbilical laparoscopic adjustable gastric banding using the SILS Port. Int J Surg 2009; 7:456-9. [PMID: 19616651 DOI: 10.1016/j.ijsu.2009.07.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 07/08/2009] [Indexed: 01/06/2023]
Abstract
BACKGROUND The rapid progression of single-incision laparoscopic surgery (SILS) into the realm of advanced surgical procedures has been fueled in recent years by the development of flexible instrumentation necessary to restore triangulation lost in the divergent nature of this approach, and multichannel ports that addressed the challenges regarding the limited range of movement of trocars in close proximity. We herein are reporting our early experience using the SILS Port to perform single incision transumbilical laparoscopic gastric banding in five of our patients. METHODS Five carefully selected female patients (body mass indices between 35 and 45kg/m(2) with peripheral obesity) underwent laparoscopic gastric banding using this single incision transumbilical technique. The same surgeon performed all surgical interventions. For all five patients, the same perioperative protocol and operative techniques were implemented. RESULTS A total of five single incision transumbilical laparoscopic gastric banding procedures were successfully performed using this technique. Mean operative time was 111min. There were no mortalities or postoperative complications noted during the mean follow-up period of 1.5 months. CONCLUSION Single incision transumbilical laparoscopic adjustable gastric banding using SILS Port is a safe and feasible evolving approach. The intraumbilical location of the implanted port facilitates access for subsequent adjustments and provides patients with an improved cosmetic outcome.
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Affiliation(s)
- Alan A Saber
- Michigan State University, Kalamazoo Center for Medical Studies, 1000 Oakland Drive, Kalamazoo, MI 49008, USA.
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Lee YY, Kim TJ, Kim CJ, Kang H, Choi CH, Lee JW, Kim BG, Lee JH, Bae DS. Single-port access laparoscopic-assisted vaginal hysterectomy: a novel method with a wound retractor and a glove. J Minim Invasive Gynecol 2009; 16:450-3. [PMID: 19487164 DOI: 10.1016/j.jmig.2009.03.022] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 03/20/2009] [Accepted: 03/27/2009] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To present our initial experience with single port-access laparoscopic-assisted vaginal hysterectomy (SPA-LAVH) by use of a wound retractor and a glove. DESIGN Continuing, prospective study (Canadian Task Force classification II-3). SETTING University teaching, research hospital, and a tertiary care center. PATIENTS We performed the SPA-LAVH in 24 patients from May 6, 2008, through October 8, 2008. INTERVENTIONS All cases of SPA-LAVH were performed by a single surgeon (T. J. K.). MEASUREMENTS AND MAIN RESULTS We analyzed the data to determine the outcome of SPA-LAVH and compared the initial 10 cases (group A) and the latter 14 cases (group B) to consider the learning curve. Median and range are used to describe non-normal data. A total of 24 consecutive patients have undergone SPA-LAVH, for benign gynecologic conditions, including 16 uterine myomas and 8 cases of adenomyosis, regardless of body mass index or previous abdominal or pelvic surgery. All cases but 3 were performed exclusively through a single port. The median operative time, weight of the uterus, and estimated blood loss were 119 minutes (range 90 to 255 minutes), 347 g (range 225 to 732 g), and 400 mL (range 100 to 1000 mL), respectively. The decline in hemoglobin from before surgery to postoperative day 1 was from 0.7 to 4.3 g/dL, with a median of 2.05 g/dL. The median hospital stay (postoperative day) was 3 days (range 3 to 7). When we compared the operative outcomes between the 2 groups, there was a tendency toward a decreased operative time in group B, although the difference was not significant. However, there was a significant decrease in the estimated blood loss and hospital stay in group B (p = .00, = .04, respectively). CONCLUSION The SPA-LAVH was safe and effective, and the procedure could be learned over a short period of time. Additional experience and continued investigation are warranted.
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Affiliation(s)
- Yoo-Young Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea
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Single-port endoscopic cholecystectomy: a bridge between laparoscopic and translumenal endoscopic surgery. ACTA ACUST UNITED AC 2009; 16:633-8. [PMID: 19373428 DOI: 10.1007/s00534-009-0108-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 02/19/2009] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVE The intentional puncture of the normal viscera is likely the most important issue limiting the widespread use of natural orifice translumenal endoscopic surgery (NOTES). We developed a new procedure for cholecystectomy using a flexible endoscope via a single port placed in the abdominal wall without visceral puncture (single-port endoscopic cholecystectomy; SPEC) as a bridge between laparoscopic surgery and NOTES. This study aimed to evaluate the technical feasibility of SPEC. METHODS Five pigs were subjected to SPEC. An endoscope was inserted through a 12-mm port placed in the right upper abdomen. After grasping and retracting the gallbladder using a 2-mm retractor that was directly introduced into the peritoneal cavity, gallbladder excision with ligation of the cystic artery and duct using endoclips was carried out. RESULTS A complete gallbladder excision was carried out easily and safely in all cases. No major adverse events occurred. The mean operating time was 67 min (range 52-84 min). CONCLUSIONS SPEC is a technically feasible procedure. It is simpler, easier, and safer than NOTES cholecystectomy. SPEC could be a less invasive alternative to the conventional four-port laparoscopic cholecystectomy.
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Nguyen NT, Slone J, Reavis KM, Woolridge J, Smith BR, Chang K. Laparoscopic transumbilical gastrojejunostomy: an advanced anastomotic procedure performed through a single site. J Laparoendosc Adv Surg Tech A 2009; 19:199-201. [PMID: 19243266 DOI: 10.1089/lap.2008.0365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Single-site laparoscopic surgery and natural orifice transumbilical surgery (NOTUS) have become exciting areas of surgical development. However, most reported case series consist of basic laparoscopic procedures, such as cholecystectomy and appendectomy. In this paper, we present the case of an advanced laparoscopic operation-construction of a gastrointestinal anastomosis-that was performed through ports placed entirely within the umbilicus. METHODS In this paper, we describe a 61-year-old male with a history of advanced pancreatic carcinoma who was referred with a gastric outlet obstruction. A laparoscopic gastrojejunostomy bypass, using a linear stapler with suture closure of the enterotomy, was performed through three abdominal trocars placed entirely within the umbilicus. Some potential advantages of NOTUS palliative gastrojejunostomy include reduced postoperative pain and the lack of visible abdominal scars. RESULTS The operation was completed uneventfully in 40 minutes. The patient recovered without complications and was discharged on postoperative day 2. At 1-month follow-up, the patient had improved oral intake without any further vomiting symptoms. CONCLUSION This case report documents the feasibility of an advanced anastomotic gastrojejunostomy procedure which can be performed through a single site. However, benefits of this approach, compared to conventional laparoscopic procedures, will require a prospective randomized clinical trial.
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Affiliation(s)
- Ninh T Nguyen
- Departments of Surgery and Medicine, University of California Irvine Medical Center, Orange, California 92868, USA.
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