• Ergonomic posture
• Gynecologic
• Hands-on performance
• Laparoendoscopic single-site Surgery (LESS)
• Learning and teaching curve

• Female
• Humans
• Learning Curve
• Laparoscopy/methods
• Ergonomics
• Gynecologic Surgical Procedures/methods
• Upper Extremity

• 23ZR1451600 Natural Science Foundation Shanghai Project

• robot-assisted
• robotic surgery
• single-port
• urologic surgery
• urology

• Humans
• Robotics
• Robotic Surgical Procedures/methods
• Urology
• Prospective Studies
• Laparoscopy/methods

• RAPN
• SP
• nephrectomy
• nephrooureterectomy
• partial nephrectomy
• pyeloplasty
• renal surgery
• robotic
• single-port

• laparoscopy
• robotic surgical procedures
• uterine fibroids
• uterine myomectomy

• Cosmesis
• LESS Surgery
• Laparo-endoscopic single site (LESS)
• Minimally invasive surgery
• Perception

• Adult
• Aged
• Attitude
• Body Image/psychology
• Female
• Humans
• Laparoscopy/methods
• Laparoscopy/psychology
• Male
• Middle Aged
• Patient Satisfaction
• Postoperative Period
• Self Report

• laparoscopic cholecystectomy
• learning curve
• neodymium magnets
• single port

• laparoendoscopic single-site surgery
• magnetic anchoring
• surgical robot system
• uncalibrated visual servo control

Surgeries with single port access have been gaining ground among surgeons who seek minimally invasive procedures. Although this technique uses only one access, the incision is larger when compared to laparoscopic cholecystectomy and this fact can lead to a higher incidence of incisional hernias.

To compare the incidence of incisional hernia after laparoscopic cholecystectomy and by single port.

A total of 57 patients were randomly divided into two groups and submitted to conventional laparoscopic cholecystectomy (n=29) and laparoscopic cholecystectomy by single access (n=28). The patients were followed up and reviewed in a 40.4 month follow-up for identification of incisional hernias.

Follow-up showed 21,4% of incisional hernia in single port group and 3.57% in conventional technique.

There was a higher incidence of late incisional hernia in patients submitted to single port access cholecystectomy compared to conventional laparoscopic cholecystectomy.

Bariatric surgery is an established and effective treatment, not only to combat morbid obesity, but also to address associated metabolic comorbidities. At this time, the cutoff for bariatric or metabolic surgery in terms of body mass index (BMI) is decreasing, making it more feasible for certain individuals to consider minimally invasive surgical options. Innovations in the technique have led to the application of laparoendoscopic single-site surgery (LESS) in the field of bariatrics, which uses a single or no incision in the performance of weight-reducing surgery. To date, there is no consensus regarding patient selection though most candidates for single-port bariatric surgery are female. Some doctors suggest that single-port bariatric surgery may not be recommended in patients with BMI of more than 50 kg/m², height of more than 180 cm, and xiphoid–umbilicus distance of more than 20 cm. Sleeve gastrectomy (SG) is now the most widely performed bariatric surgery worldwide and single-port SG (SPSG) is already established as a routine procedure in various institutions. Current evidence shows that SPSG is less painful and demonstrates higher rates of patient satisfaction regarding the wound. SPSG is feasible and is recommendable in patients who meet certain criteria. Furthermore, endoscopic treatment modalities such as intragastric balloons and endoluminal malabsorptive devices are being developed to bridge the gap between medical and surgical treatments. Nevertheless, there is still insufficient evidence to prove the superiority of LESS bariatric surgery over conventional laparoscopic surgery. Large, well-designed prospective analyses are needed to determine the criteria for selecting patients suitable to undergo LESS bariatric surgery and to predict the procedure’s role in the growth of bariatric surgery.

• Bariatric surgery
• Endoscopy
• Laparoscopy
• Obesity

• Hernia
• inguinal
• single-site

• LESS
• surgical instrument
• workload

• Adult
• Biomechanical Phenomena
• Computer Simulation
• Endoscopy/instrumentation
• Ergonomics
• Female
• Forearm/physiopathology
• Humans
• Laparoscopy/instrumentation
• Male
• Middle Aged
• Movement
• Musculoskeletal Pain/etiology
• Occupational Health
• Posture
• Rotation
• Shoulder/physiopathology
• Task Performance and Analysis
• Upper Extremity/physiopathology
• Workload
• Wrist/physiopathology

The inguinal hernia is one of the most frequent surgical diseases, being frequent procedure and surgeon´s everyday practice.

To present technical details in making hernioplasty using robotic equipment on bilateral inguinal hernia repair with single port and preliminary results with the method.

The bilateral inguinal hernia repair was performed by using the Single-Site^(c) Da Vinci Surgical Access Platform to the abdominal cavity and the placement of clamps.

This technique proved to be effective for inguinal hernia and have more aesthetic result when compared to other techniques.

Inguinal hernia repair robot-assisted with single-trocar is feasible and effective. However, still has higher costs needing surgical team special training.

• MIS
• clinical needs
• metrics
• normativity
• standards
• surgical robots

• finite element method
• in vivo visual robot system
• laparoendoscopic single-site surgery
• master-slave control

• Fundoplication
• GERD
• LESS
• Laparoendoscopic single-site
• Nissen

Transareola single-site laparoendoscopic thyroidectomy (TASSET) is a rapidly advancing minimally invasive procedure. The purpose of this study was to evaluate the learning curve for TASSET.

The aim of this study was to assess the surgical and oncological outcome for the management of endometrial cancer (EC) by laparoendoscopic single-site surgery (LESS).

We performed a retrospective chart review of patients who underwent a LESS for EC. All the patients were treated by the same surgical team between July 2009 and June 2013 at the Gynaecologic Oncologic Unit, Regina Elena National Cancer Institute, Rome, Italy.

A total of 50 women were included, with a median age of 45 years (range, 39-84 years) and a median body mass index (BMI) of 21.8 kg/m² (range, 19-48 kg/m²). Median operative time was 100 min (range, 50-240 min), median blood loss was 90 mL (range, 10-300 mL) and median hospital stay was 3 days (range, 2-9 days). The median number of pelvic lymph nodes retrieved was 14 (range, 5-20). No intraoperative complications occurred, but there were 4 postoperative complications. Two patients required a laparoscopic conversion. The median follow-up was 36 months (range, 16-62 months) and no recurrence occurred.

Our report showed that the LESS approach in the treatment of early EC can be a safe and reliable technique in terms of surgical and oncological outcomes.

• Animal model
• Cholecystolithiasis
• Laparoscopic cholecystectomy
• Learning curve
• NOTES

• Blood Loss, Surgical/statistics & numerical data
• Endoscopy/adverse effects
• Endoscopy/methods
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Length of Stay/statistics & numerical data
• Living Donors
• Nephrectomy/adverse effects
• Nephrectomy/methods
• Operative Time
• Pain Measurement
• Pain, Postoperative
• Randomized Controlled Trials as Topic
• Transplant Donor Site

With the cooperation of surgeons and the engineering division of the company Bhio supply^© (Esteio-RS, Brazil), a permanent single port was developed.

An experimental study assessed the safety and efficacy of the device using a swine laparoscopic appendectomy model (right salpingo-oophorectomy).

Experimental randomised study.

A total of 20 pigs were randomised for the conventional laparoscopic (CL) three-trocar technique or the single Centry port (CPort) with two working channels, aided by a transparietal thread. Operative times, surgical complications, CO₂ use, and pneumoperitoneal pressure were checked. Pressure and chromopertubation tests assessed the ligatures.

For quantitative outcomes, the Fisher's exact test analysed the samples to compare the surgeons in each group, the ANOVA test for parametric data (volume and pressure) and the Student's t-test for analysis of the fascial incision length. The binaries and isolated occurrence events were described in percentages.

For all cases, pneumoperitoneum was maintained. The CPort group, however, resulted in higher CO₂ use (26.18 l; standard deviation [SD] ± 11.09) than CL group (5.69 l; SD ± 2.44) (P < 0.01). The mean pressure in CPort group (6.604 mmHg, SD ± 1.793) was comparatively lower than in CL group (7.382 mmHg, SD ± 1.833) (P = 0.363). There was no statistical difference between operative times, ligature safety or adverse surgical events between the different groups and surgeons.

The surgical technique used with the single port showed no differences in safety and efficacy. Though it does require more CO₂ use, its working dynamics did not lead to increased operative times. The results were similar between the two surgeons in the study, suggesting that they can be reproduced.

• Appendectomy
• laparoscopic surgery
• minimally invasive surgery
• single port

• LESS
• Laparoscopy
• Pediatrics
• Surgery
• Urology

Single-incision laparoscopic surgery is gaining popularity among minimally invasive surgeons and is now being applied to a broad number of surgical procedures. Although this technique uses only 1 port, the diameter of the incision is larger than in standard laparoscopic surgery. The long-term incidence of port-site hernias after single-incision laparoscopic surgery has yet to be determined.

All patients who underwent a single-incision laparoscopic surgical procedure from May 2008 through May 2009 were included in the study. Single-incision laparoscopic surgical operations were performed either by a multiport technique or with a 3-trocar single-incision laparoscopic surgery port. The patients were seen at 30 to 36 months' follow-up, at which time they were examined for any evidence of port-site incisional hernia. Patients found to have hernias on clinical examination underwent repairs with mesh.

A total of 211 patients met the criteria for inclusion in the study. The types of operations included were cholecystectomy, appendectomy, sleeve gastrectomy, gastric banding, Nissen fundoplication, colectomy, and gastrojejunostomy. We found a port-site hernia rate of 2.9% at 30 to 36 months' follow-up.

Port-site incisional hernia after single-incision laparoscopic surgical procedures remains a major setback for patients. The true incidence remains largely unknown because most patients are asymptomatic and therefore do not seek surgical aid.

In this single-institution study, we aimed to compare the safety, feasibility, and outcomes of single-incision laparoscopic sigmoidectomy (SILSS) with multiport laparoscopic sigmoidectomy (MLS) for recurrent diverticulitis.

Between October 2011 and February 2013, 60 sigmoidectomies were performed by the same surgeon. Forty patients had a MLS and 20 patients had a SILSS. Outcomes were compared.

Patient characteristics were similar. There was no difference in morbidity, mortality or readmission rates. The mean operative time was longer in the SILSS group (P = .0012). In a larger proportion of patients from the SILSS group, 2 linear staplers were needed for transection at the rectum (P = .006). The total cost of disposable items was higher in the SILSS group (P < .0001). No additional ports were placed in the SILSS group. Return to bowel function or return to oral intake was faster in the SILSS group (P = .0446 and P = .0137, respectively). Maximum pain scores on postoperative days 1 and 2 were significantly less for the SILSS group (P = .0014 and P = .047, respectively). Hospital stay was borderline statistically shorter in the SILSS group (P = .0053). SILSS was also associated with better cosmesis (P < .0011).

SILSS is feasible and safe and is associated with earlier recovery of bowel function, a significant reduction in postoperative pain, and better cosmesis.

• Diverticulitis
• Single incision laparoscopic sigmoidectomy

Parastomal hernias (PSHs) are a frequent complication and remain a surgical challenge. We present a new option for single-port PSH repair with equilateral stoma relocation using preshaped, prosthetic 3-dimensional implants and flat mesh insertion in intraperitoneal onlay placement for additional augmentation of the abdominal wall.

We describe our novel technique in detail and performed an analysis of prospectively collected data from patients who underwent single-port PSH repair, focusing on feasibility, conversions, and complications.

From September 2013 to January 2014, 9 patients with symptomatic PSHs were included. Two conversions to reduced-port laparoscopy using a second 3-mm trocar were required because of difficult adhesiolysis, dissection, and reduction of the hernia sac content. No major intra- or postoperative complications or reoperations were encountered. One patient incurred a peristomal wound healing defect that could be treated conservatively.

We found that single-port PSH repair using preshaped, elastic 3-dimensional devices and additional flat mesh repair of the abdominal wall is feasible, safe, and beneficial, relating to optimal coverage of unstable stoma edges with wide overlap to all sides and simultaneous augmentation of the midline in the IPOM technique. The stoma relocation enables prolapse treatment and prevention. The features of a modular and rotatable multichannel port system offer benefits in clear dissection ongoing from a single port. Long-term follow-up data on an adequate number of patients are awaited to examine efficacy.

• Laparoscopic repair
• Parastomal hernia
• Prevention
• Single incision
• Single port
• Single site

• Endoscopy
• Hernia
• Laparoscopy
• Meta-analysis
• Single-site surgery

• Hernia, Inguinal/surgery
• Herniorrhaphy/adverse effects
• Herniorrhaphy/methods
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods

This is to describe a case of a morbidly obese (BMI = 40) female with retrocaval ureter treated with laparoendoscopic single-site surgery. A JJ stent was positioned. A 2 cm umbilical access was created. A single port platform was positioned. The entire ureter was mobilized posterior to the vena cava and transected where the dilated portion ended. The distal ureter was repositioned lateral to the inferior vena cava. Anastomosis was done. A 3 mm trocar was used to assist suturing. At 4-month follow-up, CT revealed no evidence of obstruction of the right kidney and the patient was symptomless. Although challenging, in a morbidly obese patient, LESS repair for retrocaval ureter is feasible.

• LESS
• Retrocaval

• Cholecystectomy
• Laparoscopy
• Morbidity
• Single incision

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Body Height
• Body Weight
• Cholecystectomy, Laparoscopic/methods
• Feasibility Studies
• Female
• Gallbladder Diseases/surgery
• Humans
• Male
• Middle Aged
• Operative Time
• Retrospective Studies
• Risk Factors
• Young Adult

• Appendectomy/methods
• Appendectomy/trends
• Cholecystectomy, Laparoscopic/methods
• Cholecystectomy, Laparoscopic/trends
• Congresses as Topic
• Digestive System Surgical Procedures/adverse effects
• Digestive System Surgical Procedures/economics
• Digestive System Surgical Procedures/methods
• Digestive System Surgical Procedures/trends
• Esophageal Achalasia/surgery
• Humans
• Minimally Invasive Surgical Procedures/adverse effects
• Minimally Invasive Surgical Procedures/economics
• Minimally Invasive Surgical Procedures/methods
• Minimally Invasive Surgical Procedures/trends
• Natural Orifice Endoscopic Surgery/methods
• Natural Orifice Endoscopic Surgery/trends
• Operative Time

• Laparoendoscopic single-site surgery
• Product safety courses
• Single-incision laparoscopic surgery

• Cholecystectomy/methods
• Conversion to Open Surgery/statistics & numerical data
• Cost-Benefit Analysis
• Endoscopy/economics
• Endoscopy/methods
• Europe
• Hepatectomy/methods
• Humans
• Laparoscopy/methods
• Pancreatectomy/methods
• Robotics/economics
• Robotics/methods
• Societies, Medical

The aim of this retrospective study was to compare conventional laparoscopic living-donor nephrectomy with transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy in terms of feasibility and reproducibility.

A total of 115 consecutive female patients who underwent laparoscopic living-donor nephrectomy (n = 70) or transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy (n = 45) were included and compared in terms of operative characteristics, as well as donor and recipient outcomes.

No significant difference was observed between the laparoscopic living-donor nephrectomy and transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy groups in terms of mean duration of warm and cold ischemia, operation time, length of hospital stay, arterial anastomoses, visual analog scale pain scores, serum creatinine levels, and receiver outcomes, whereas a significantly higher number of venous anastomoses was noted in the laparoscopic living-donor nephrectomy group than in the transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy group (P = .029).

Transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy seems to be a feasible and reproducible alternative to conventional laparoscopic living-donor nephrectomy in female donors provided the viability of the vagina as an organ retrieval route.

• Laparoscopy approach
• Living-donor nephrectomy
• Transvaginal laparoscopy

Laparo Endoscopic Single-site Surgery (LESS) represents an evolution of minimally invasive surgery and aims to improve cosmetic outcome and reduce surgical trauma and complications associated with traditional laparoscopy. This study was performed to present our preliminary experience in bilateral spermatic cord ligation with the LESS technique and compare the results with the outcomes of conventional laparoscopic surgery.

Between June 2007 and May 2013, 24 patients were referred to our institute for bilateral varicocelectomy. The indications for this type of procedure were bilateral varicocele with impairment of semen parameters or chronic bilateral testicular pain. All procedures were performed via the same surgeon. The patients were divided into two groups according to the type of laparoscopic surgery. Group A included 10 patients underwent LESS technique while group B included the remaining 14 patients that underwent conventional laparoscopy.

The comparison between the two techniques showed some important advantages for LESS: shorter operating time (45.4 min vs. 88.3 (P < .001), shorter hospital stay (16.6 hours vs. 51.4 hours) (P < .001), early return to the normal activity (2.3 days vs. 4.7 days) and better cosmetic outcomes. No conversions from LESS to conventional laparoscopy were necessary and blood loss was insignificant in all patients.

All patients in the LESS group reported full satisfaction with the cosmetic outcome, whereas 85.7% of patients after conventional laparoscopy were fully satisfied with cosmesis.

Bilateral spermatic cord ligation with LESS is an alternative to conventional laparoscopy. The procedure was successfully performed in all patients. The trans-umbilical approach offers the advantage of a better cosmetic result, shorter hospital stay and less postoperative pain.